Adolescent Confidentiality and Women's Health: History, Rationale, and Current Threats.

Adolescent access to reproductive health services, mental health services, and treatment of drug and alcohol use depends on teens' rights to consent and confidentiality in the state in which they live. This article reviews the history, current practices, and potential challenges to confidentiality, including Title X funding, questions about brain development and ability to make autonomous choices, and meaningful use practices in electronic records. Resources are provided for professional position statements and individual state regulations.

[Processes of attention to children and adolescents under 20 years in La Castañeda: evolution of the concept of childhood in psychiatry]. / Procesos de atención a menores de 20 años en La Castañeda: evolución del concepto de infancia en psiquiatría.

Today, there is evidence that shows that children and adolescents can experience developmental problems and psychiatric disorders. This was possible because of two main reasons, the evolution of the concept of infancy and the progress made in medical and psychiatric diagnostic classification. This manuscript offers a glance to early psychiatric attention in Mexico, particularly the care processes provided to 36 children and adolescents under twenty, admitted in the mental asylum La Castañeda, during the first half of the XX century. Admission causes, length of stay, diagnosis, treatment and discharge motives, are some of the aspects described in this study. Finally, it also reflects about the challenge it is for a child psychiatric hospital nowadays, with such a history, to become an innovative institution able to claim a place in the medical field in favor of those minors that can barely defend themselves.

Resumen: Existe evidencia de que los niños y adolescentes pueden presentar problemas del desarrollo y trastornos psiquiátricos. Lo anterior es consecuencia del concepto de infancia y del refinamiento de las clasificaciones diagnósticas médico-psiquiátricas. Este artículo ofrece una mirada sobre los procesos de atención psiquiátrica brindados a 36 niños y adolescentes admitidos en el Manicomio La Castañeda en la primera mitad del siglo XX. Motivo de ingreso, tiempo de estancia, diagnósticos establecidos, tratamiento y motivo de egreso son algunos de los aspectos que se describen. Finalmente, se reflexiona sobre la existencia de un hospital psiquiátrico infantil, que siendo testimonio del pasado, tiene al mismo tiempo el desafío de convertirse en una institución innovadora; sitio que en el ámbito de las especialidades médicas reclama la psiquiatría infantil a favor de los menores que difícilmente pueden abogar por sí mismos.

Procesos de atención a menores de 20 años en La Castañeda: evolución del concepto de infancia en psiquiatría / Processes of attention to children and adolescents under 20 years in La Castañeda: evolution of the concept of childhood in psychiatry

Resumen: Existe evidencia de que los niños y adolescentes pueden presentar problemas del desarrollo y trastornos psiquiátricos. Lo anterior es consecuencia del concepto de infancia y del refinamiento de las clasificaciones diagnósticas médico-psiquiátricas. Este artículo ofrece una mirada sobre los procesos de atención psiquiátrica brindados a 36 niños y adolescentes admitidos en el Manicomio La Castañeda en la primera mitad del siglo XX. Motivo de ingreso, tiempo de estancia, diagnósticos establecidos, tratamiento y motivo de egreso son algunos de los aspectos que se describen. Finalmente, se reflexiona sobre la existencia de un hospital psiquiátrico infantil, que siendo testimonio del pasado, tiene al mismo tiempo el desafío de convertirse en una institución innovadora; sitio que en el ámbito de las especialidades médicas reclama la psiquiatría infantil a favor de los menores que difícilmente pueden abogar por sí mismos.

Abstract: Today, there is evidence that shows that children and adolescents can experience developmental problems and psychiatric disorders. This was possible because of two main reasons, the evolution of the concept of infancy and the progress made in medical and psychiatric diagnostic classification. This manuscript offers a glance to early psychiatric attention in Mexico, particularly the care processes provided to 36 children and adolescents under twenty, admitted in the mental asylum La Castañeda, during the first half of the XX century. Admission causes, length of stay, diagnosis, treatment and discharge motives, are some of the aspects described in this study. Finally, it also reflects about the challenge it is for a child psychiatric hospital nowadays, with such a history, to become an innovative institution able to claim a place in the medical field in favor of those minors that can barely defend themselves.

The success factors of scaling-up Estonian sexual and reproductive health youth clinic network--from a grassroots initiative to a national programme 1991-2013.

BACKGROUND: A growing number of middle-income countries are scaling up youth-friendly sexual and reproductive health pilot projects to national level programmes. Yet, there are few case studies on successful national level scale-up of such programmes. Estonia is an excellent example of scale-up of a small grassroots adolescent sexual and reproductive health initiative to a national programme, which most likely contributed to improved adolescent sexual and reproductive health outcomes. This study; (1) documents the scale-up process of the Estonian youth clinic network 1991-2013, and (2) analyses factors that contributed to the successful scale-up. This research provides policy makers and programme managers with new insights to success factors of the scale-up, that can be used to support planning, implementation and scale-up of adolescent sexual and reproductive health programmes in other countries. METHODS: Information on the scale-up process and success factors were collected by conducting a literature review and interviewing key stakeholders. The findings were analysed using the WHO-ExpandNet framework, which provides a step-by-step process approach for design, implementation and assessment of the results of scaling-up health innovations. RESULTS: The scale-up was divided into two main phases: (1) planning the scale-up strategy 1991-1995 and (2) managing the scaling-up 1996-2013. The planning phase analysed innovation, user organizations (youth clinics), environment and resource team (a national NGO and international assistance). The managing phase examines strategic choices, advocacy, organization, resource mobilization, monitoring and evaluation, strategic planning and management of the scale-up. CONCLUSIONS: The main factors that contributed to the successful scale-up in Estonia were: (1) favourable social and political climate, (2) clear demonstrated need for the adolescent services, (3) a national professional organization that advocated, coordinated and represented the youth clinics, (4) enthusiasm and dedication of personnel, (5) acceptance by user organizations and (6) sustainable funding through the national health insurance system. Finally, the measurement and recognition of the remarkable improvement of adolescent SRH outcomes in Estonia would not have been possible without development of good reporting and monitoring systems, and many studies and international publications.

Health care for refugee children during the Greek Civil War (1946-1949).

This paper focuses on physical and psychological traumas of children during and after the Greek Civil War (1946-1949). There were two evacuation programmes: one organised by the Greek Communist Party to seven countries of Eastern Europe and the other by the Greek government and Queen Frederica to children's homes (paidopoleis) in the country. The paper also argues that Greek refugee children experienced war terror and violence, voluntary or forced separation from their families, and institutionalisation for a shorter or longer time, and that both sides sought to provide shelter, food, medical treatment, and psychological support to the victims.

In high school and pregnant: the importance of educational and fertility expectations for subsequent outcomes.

This study uses the High School and Beyond data (1980­1992) to examine the importance of educational and fertility expectations in explaining the achievement gap of adolescent mothers for over 5,500 young women from different socioeconomic backgrounds. Using a non-parametric local propensity score regression, the study finds that the economic disadvantage associated with having a child in high school is particularly large in poor socioeconomic environments; however, this disadvantage is a result of preexisting differences in the educational and fertility expectations and is not because of a diminished capacity of the socioeconomic environment to mediate the effect of an unplanned childbirth. The findings suggest that childcare assistance and other policies designed to alleviate the burden of child rearing for young mothers of low means may not produce the desired improvement in their subsequent educational and labor market outcomes. A much earlier policy intervention with a focus on fostering young women's outlook for the future is needed.

[Brief history of creation and activities of Research Institute of Hygiene and Health Protection of Children and Adolescents State Institution Research Centre of Children's Health Protection, Russian Academy of Medical Sciences].

The Institute was founded to study effects of environmental factors on the health status and day-to-day activities of children and adolescents in organized groups and to use the data obtained for the elaboration of measures for the protection and promotion of their health. The Institute is up to now the sole research institution of this kind in the Russian Federation entitled to coordinate problem-solving efforts on a national scale. Since 2000, it has been functioning as the National Centre for support of the European network of health promoting schools. The Institute developed a concept of research designed to resolve topical problems facing hygienic science and practical health service; it implicates elaboration of hygienic norms and regulations taking into account age, sex, health status, and the level of mental and physical development of individual children. The main lines of research carried out at the Institute are listed with special reference to the theoretical aspects of such cardinal problems of child hygiene as adaptation, hygienic regulation and standardization, etc. The Institute participated in the development of a new basic curriculum and the state education standard law. The authors present results of multidisciplinary research and developments obtained at the Institute. Specialists of the Institute are involved in the work of international scientific societies.

[History of the foundation and activities of the Research Institute for the Hygiene and Health Care of Children and Adolescents, Research Center of Children's Health].

The paper presents data on the history of foundation of the Research Institute for the Hygiene and Health Care of Children and Adolescents. The Institute is reported to have established to study the influence of factors of the vital activity environment and the health status and capability of children and adolescents, and the development, on this basis, of measures aimed at maintaining and promoting the health status of the rising generation. The Institute is the only research establishment of this profile in the Russian Federation, the leading scientific institution on this problem. Since 2000, the Institute has been the national center for supporting the European network of health promotion schools. By taking into account the tasks posed by hygienic science and practical health care, the Institute has developed a research concept stemming from the peculiarities of the body at each stage of development and, in this connection, hygienic standards and regulations in terms of the sex, age, health status, and achieved development of a child. The paper lists research areas, teaching points of cardinal problems of childhood hygiene, such as adaptation, hygienic rationing. The Institute took part in the development of hygienic standards, a new basic school-based educational program, and the Law on State Educational Standard. Research developments obtained from the Institute's multidimensional studies are outlined. The specialists of the Institute are actively involved in the activity of international medical associations.

Child psychoanalytic psychotherapy in the UK National Health Service: an historical analysis.

This review developed from a discussion with the late Professor Richard Harrington about interventions in Child and Adolescent Mental Health services (CAMHS) that lacked an evidence base. Our aim is to investigate the literature for signs that child psychoanalysis is a declining paradigm within the Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK). We present the literature chronologically since the inception of the UK National Health Service. This study shows that there have been a number of threats to child psychoanalytic psychotherapy, but no significant consistent decline. The profession is beginning to develop the social profile of a scientific discipline. We conclude that child psychoanalytic psychotherapy does not consistently demonstrate features of a declining scientific paradigm.

A saúde mental do adolescente entre duas políticas públicas: o Programa Saúde do Adolescente (PROSAD) e a política de saúde mental / Mental health of the adolescent between two public policies: Adolescent´s Health Program (PROSAD) and mental health policy

Este estudo trata da saúde mental do adolescente a partir da formulação das políticas de Saúde do Adolescente (PROSAD) e de Saúde Mental, buscando compreender os debates que então se travaram em torno das questões relativas à adolescência, especialmente em relação à assistência à saúde mental, e identificando as concepções e interpretações que se apresentavam no posicionamento dos formuladores no processo de implementação das políticas no período entre 1989 e 2005. Para tal, analisamos documentos oficiais e discursos produzidos pelas políticas e realizamos entrevistas com coordenadores, gestores, ex-gestores e atores-chaves implicados em suas formulações e processos. Destacamos que, apesar de encontrarem condições de possibilidades como Políticas Nacionais no mesmo período –marcado por profundas mudanças no país, onde destacamos a instituição do SUS –, elas assumem modelos de intervenção e recortam seu objeto diferentemente e em momentos distintos, o que resulta em descompassos e hiatos que guardam certa relação com as formas de inserção nesse processo de mudança na saúde. Quando a análise se volta para a aparente intercessão das políticas no que diz respeito à saúde mental do adolescente, percebemos que dentro da perspectiva de responder ao conjunto das necessidades de cuidado da população adolescente no país, a maioria das situações que dizem respeito à saúde mental não se situa em uma e nem em outra, mas num entre as duas políticas. O entre, como lugar construído e político, aponta para uma realidade que é mais complexa do que os recortes que as políticas operam. Isso não quer dizer que as políticas públicas analisadas não se encontrem; no entanto, os encontros ou as parcerias estabelecidas acontecem, em determinados momentos, voltados para ações e projeto específicos...

Sin opción a decidir reflejos de la inequidad social / Without option to decide reflections of the social inequity

Presenta historias de adolescentes con embarazos no deseados que pusieron en peligro su vida o la perdieron, por no tener acceso a servicios de salud de calidad, oportuno y adecuados, que resolvieran los problemas particulares que presentaba cada una. También se recoge la historia de una joven que conservó su salud y su vida mediante el acceso a un aborto terapeútico. Sus voces muestran que el conocimiento y la defensa de los derechos reproductivos es un asunto de vida o muerte para las mujeres y un indicador de desarrollo para el país donde viven. Estos testimonios documentan la realida a la que se ven enfrentadas las mujeres de la región centroamericana cuando buscan atención médica para conservar su salud y su vida. Las historias de estas vidas fueron contadas por las propias, sobrevivientes o por sus familiares mas cercanas

Adolescent medicine with a 100 year perspective.

Adolescent medicine was born out of scientific advances from a wide variety of disciplines, changes in societal mores and the explosion of technology that occurred during the 20th century. The past 100 years of clinical practice and research have provided a wealth of information that has improved our understanding of the biologic and physical development of adolescents as well as the epidemiology of high-risk adolescent behaviors. The present challenge for all providers of health care to adolescents is to continue to examine the effect of these high-risk behaviors and develop mechanisms to address and limit the impact of these behaviors, just as the scientists and practitioners of the 20th century made great strides in treatment and cure of medical illnesses. With a broad base of scientific knowledge, formalization into an academic field and strong government and organizational support adolescent medicine are energized by these factors and can only envision continued growth in this important field of medicine.

International developments in adolescent health care: a story of advocacy and achievement.

The contemporary health problems of young people occur within the context of the physical, social, cultural, economic, and political realities within which they live. There are commonalities and differences in this context among developed and developing countries, thus differing effects on the individual's personal as well as national development. Internationally, the origins and evolution of health care for adolescents can be viewed as an unfolding saga taking place particularly over the past 30 years. It is a story of advocacy and subsequent achievement in all corners of the world. This paper reviews the important developments in the international arena, recognizes major pioneers and milestones, and explores some of the current and future issues facing the field. The authors draw heavily on their experiences with the major nongovernmental adolescent health organizations. The special roles of the World Health Organization, Pan American Health Organization, and United Nations Children's Fund (UNICEF) are highlighted, and special consideration is given to the challenge of inclusion through youth participation.