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1.
FP Essent ; 507: 11-18, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410092

RESUMO

Communication is an essential component in providing health care for adolescent patients. A critical part of adolescence is identity development. Affirmation of identity and emphasis on individual strengths are important for this age group. The concept of resilience is at the center of adolescent care and shapes how care is defined and delivered. A primary goal is to protect patients from harm through a combination of promotion of protective factors, including resilience, and risk factor reduction. In adolescents, use of motivational interviewing has been shown to decrease risky sexual behaviors, help prevent unplanned pregnancy, increase physical activity levels, and decrease substance use. Confidentiality is another essential component of care. The American Academy of Pediatrics (AAP) recommends use of the Strengths, School, Home, Activities, Drugs/substance use, Emotions/eating/depression, Sexuality, Safety (SSHADESS) screen for psychosocial assessment. Several other standardized, validated screening tools also may be valuable in guiding discussions and identifying risky behaviors. Sexual orientation, gender identity, religious, racial, and ethnic components of identity development should be addressed. The empowerment of adolescent patients to achieve personal independence in the health care setting is part of the transition from an adolescent approach to health care to an adult approach.


Assuntos
Saúde do Adolescente , Identidade de Gênero , Adolescente , Adulto , Criança , Comunicação , Feminino , Humanos , Masculino , Gravidez , Assunção de Riscos , Comportamento Sexual , Estados Unidos
2.
FP Essent ; 507: 19-25, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410093

RESUMO

Unintentional injuries, suicide, and homicide were the leading causes of deaths among US individuals ages 10 to 24 years in 2017. Motor vehicle crashes are the leading cause of death by unintentional injury among US adolescents. Family physicians can encourage adolescent patients who drive to use safe driving practices (eg, seat belt use, cell phone-free driving, sober driving). Poisoning and drowning are the second and third most common causes of death by unintentional injury among adolescents, respectively. Suicide is the second overall leading cause of death among adolescents and is a growing problem. Depression is a risk factor. The Ask Suicide-Screening Questions (ASQ) suicide risk screening tool has been validated for use in patients ages 10 to 21 years in all medical settings. Screening, diagnosis, treatment, and follow-up of adolescent patients for depression and development of safety plans are key to suicide prevention. Homicides are the third leading cause of death among adolescents, and firearms are a clear contributor. Family physicians should assess adolescent patients for risk factors for violence, provide trauma-informed care, promote resilience and strong relationships with adults, and empower adolescents to use their strengths and skills to reduce their risk of involvement in violence.


Assuntos
Saúde do Adolescente , Suicídio , Adolescente , Adulto , Causas de Morte , Criança , Homicídio , Humanos , Suicídio/prevenção & controle , Violência , Adulto Jovem
3.
FP Essent ; 507: 26-32, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410094

RESUMO

Substance use in adolescents affects brain development and can influence health in adulthood. The substances most commonly used by adolescents are alcohol, cannabis, and tobacco. Adolescent alcohol use has been shown to inhibit and alter normal brain development, and has been associated with alcohol use disorder and other mental disorders in adulthood. Cannabis use during adolescence has been associated with adverse mental health outcomes. Adolescents may incorrectly assume that the negative health effects of smoking will not affect them. Electronic nicotine delivery systems, such as e-cigarettes, for vaping may be used to inhale nicotine, cannabis, or both. Strong family relationships and parental monitoring are protective factors against substance use. Screening at every preventive services visit is an essential element of adolescent care. The evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategy has been shown to decrease substance use and its adverse effects in adolescents. On societal and community levels, family physicians have numerous opportunities to advocate for adolescent well-being and prevention of substance use. The American Academy of Family Physicians (AAFP) recommends that family physicians advocate for legislation and governmental policies that facilitate the prevention, diagnosis, and treatment of substance use.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Transtornos Relacionados ao Uso de Substâncias , Vaping , Adolescente , Saúde do Adolescente , Adulto , Humanos , Fumar , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
4.
FP Essent ; 507: 33-38, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410095

RESUMO

Digital media use has increased rapidly during the past two decades, and media use is now a major issue in adolescent development. Online connections and communities can help foster healthy identity development and provide needed peer support, particularly for adolescents from historically marginalized communities. Online harassment, or cyberbullying, is a common phenomenon. Media use can interfere with sleep hygiene and quality, and screen-based sedentary behaviors have been associated with decreased physical activity, decreased aerobic fitness, and increased adiposity among adolescents. The literature on media use and adolescent mental health still is evolving. Some research suggests a U-shaped association between these two factors, with high and low levels of internet use associated with depression. Social media use may amplify peer pressure to engage in sexual behavior, provide exposure to a greater network of individuals with sexual experience, and increase the risk of sexual behaviors. Counseling adolescent patients about safe and healthy media use is essential. Conversations with patients and their families about media use should begin before adolescence and continue through adolescence in the context of routine preventive care. The American Academy of Pediatrics (AAP) recommends creation and implementation of a Family Media Use Plan.


Assuntos
Saúde do Adolescente , Mídias Sociais , Adolescente , Criança , Comunicação , Humanos , Internet
5.
J Hum Nutr Diet ; 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34089207

RESUMO

Nutrition post major upper gastrointestinal (UGI) cancer surgery is a significant consideration known to affect postoperative recovery and the ability to tolerate adjuvant treatment. This systematic review assessed the effect of early oral feeding (EOF), compared to traditional timing of oral feeding, following major surgery for UGI cancer on postoperative complications, postoperative length of hospital stay (LOS), nutritional status and quality of life (QOL). The literature was searched up to March 9th 2020 using CINHAL, PubMed, MEDLINE, Embase, Scopus and Web of Science databases. Quality assessment was completed using the Academy of Nutrition and Dietetics quality criteria checklist. Fifteen articles were included, consisting of seven randomised controlled trials, six cohort studies and two non-randomised trials, with a total of 2517 participants. The type and timing of EOF varied considerably across studies with limited reporting of energy and protein intakes from oral or enteral feeding. Fourteen studies assessed postoperative complications of which 13 reported no difference between EOF and standard care. Fourteen studies assessed postoperative LOS and of these, 13 reported a reduced length of stay in the EOF group. Four of 15 studies assessing nutritional status found no difference between groups. Three of 15 studies assessed QOL with inconsistent findings. This review found EOF reduced postoperative LOS and did not increase postoperative complications. However, the optimal timing for the introduction of EOF could not be established. Furthermore, the type of EOF varied considerably making comparison across studies challenging and demonstrates a need for internationally standardised definitions.

6.
Artigo em Inglês | MEDLINE | ID: mdl-27190496

RESUMO

BACKGROUND: Severe dysphagia may occur in the immune mediated necrotizing myopathies (IMNM). Neck swelling and severe dysphagia as the initial symptoms upon presentation has not been previously described. CASE PRESENTATION: A 55-year-old male with a 4 week history of neck swelling, fatigue, dysphagia, myalgias, night sweats, and cough was admitted for an elevated CK. He underwent extensive infectious and inflammatory evaluation including neck imaging and muscle biopsy. Neck CT and MRI showed inflammation throughout his strap muscles, retropharyngeal soft tissues and deltoids. Infectious work up was negative. Deltoid muscle biopsy demonstrated evidence of IMNM. Lab tests revealed anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies confirming the diagnosis of HMGCR IMNM. CONCLUSIONS: HMGCR IMNM is a rare and incompletely understood disease process. Awareness of HMGCR IMNM could potentially lead to earlier diagnosis, treatment and improved clinical outcomes as disease progression can be rapid and severe.

7.
Am J Kidney Dis ; 67(4): 593-600, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26744128

RESUMO

BACKGROUND: The Brain in Kidney Disease (BRINK) Study aims to identify mechanisms that contribute to increased risk for cognitive impairment in patients with chronic kidney disease (CKD). We describe the rationale, design, and methods of the study and report baseline recruitment and cognitive function results. STUDY DESIGN: Longitudinal observational cohort study of the epidemiology of cognitive impairment in CKD. The primary aim is to characterize the association between (1) baseline and incident stroke, white matter disease, estimated glomerular filtration rate (eGFR), inflammation, microalbuminuria, and dialysis initiation and (2) cognitive decline over 3 years in a CKD cohort with a mean eGFR<45 mL/min/1.73 m(2). SETTING & PARTICIPANTS: Community-dwelling participants 45 years or older recruited from 4 health systems into 2 groups: reduced eGFR, defined as eGFR<60 mL/min/1.73 m(2) (non-dialysis dependent), and control, defined as eGFR≥60 mL/min/1.73 m(2). PREDICTOR: eGFR group. OUTCOMES: Performance on cognitive function tests and structural brain magnetic resonance imaging. MEASUREMENTS: Sequential cognitive and physical function testing, serum and urine biomarker measurement, and brain magnetic resonance images over 3 years. RESULTS: Of 554 participants, mean age was 69.3 years; 333, 88, and 133 had eGFRs<45 (non-dialysis dependent, nontransplantation), 45 to <60, and ≥60 (controls) mL/min/1.73 m(2), respectively. Mean eGFR in reduced-eGFR participants was 34.3 mL/min/1.73 m(2). Baseline cognitive performance was significantly associated with eGFR in all domains except language. Participants with eGFRs<30 mL/min/1.73 m(2) performed significantly worse than those with eGFRs≥30 mL/min/1.73 m(2) on tests of memory, processing speed, and executive function. Participants with reduced eGFRs overall scored worst on the Immediate Brief Visual-Spatial Memory Test-Revised. LIMITATIONS: Healthy cohort bias, competing risk for death versus cognitive decline. CONCLUSIONS: Cognitive function was significantly worse in participants with eGFRs<30 mL/min/1.73 m(2). Future BRINK analyses will measure risk factors for cognitive decline using the longitudinal data.


Assuntos
Transtornos Cognitivos/etiologia , Insuficiência Renal Crônica/complicações , Idoso , Cognição , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/psicologia , Projetos de Pesquisa
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