Four steps to preserving adolescent confidentiality in an electronic health environment.

PURPOSE OF REVIEW: Best practices in adolescent care require the ability to provide confidential services, particularly for reproductive health care. As systems implement electronic health records and patients use health portals to access information and communicate with their healthcare team, special attention should be paid to protection of adolescent confidentiality in the electronic environment. RECENT FINDINGS: Professional organizations have issued guidance for electronic health records and portal use, but implementation has varied widely between systems, with multiple risks for breaches of confidentiality. Despite interest from patients and families, adolescent health portal use remains low. SUMMARY: Understanding the legal and electronic environments in which we care for adolescent patients allows us to educate, advocate, and implement our electronic tools in a way that respects our adolescent patients' need for confidential care, the importance of their caregivers in promoting their health, and the legal rights of both.

Validity and reliability of the Cyber-aggression Questionnaire for Adolescents (CYBA) / Validez y fiabilidad del Cuestionario de Ciberagresión para Adolescentes (CYBA)

Cybercrime is a growing and worrisome problem, particularly when it involves minors. Cyber-aggression among adolescents in particular can result in negative legal and psychological consequences for people involved. Therefore, it is important to have instruments to detect these incidents early and understand the problem to propose effective measures for prevention and treatment. This paper aims to design a new self-report, the Cyber-Aggression Questionnaire for Adolescents (CYBA), to evaluate the extent to which the respondent conducts aggressions through a mobile phone or the internet and analyse the factorial and criterion validity and reliability of their scores in a sample of adolescents from Asturias, Spain. The CYBA was administered to 3,148 youth aged between 12 and 18 years old along with three self-reports to measure aggression at school, impulsivity, and empathy. Regarding factorial validity, the model that best represents the structure of the CYBA consists of three factors (Impersonation, Visual-sexual Cyber-aggression, and Verbal Cyber-aggression and Exclusion) and four additional indicators of Visual Cyber-aggression-Teasing/Happy Slapping. Regarding criterion validity, the score on the CYBA correlates positively with aggression at school and impulsivity and negatively with empathy. That is the way cyber-aggression correlates with these three variables, according to previous empirical evidence. The reliability of the scores on each item and factor of the CYBA are adequate. Therefore, the CYBA offers a valid and reliable measure of cyber-aggression in adolescents (AU)

Los ciberdelitos constituyen un problema creciente y preocupante, sobre todo si están involucrados menores. Las ciberagresiones en adolescentes, en concreto, pueden generar consecuencias legales y psicológicas muy negativas para los implicados. Es importante, por tanto, disponer de instrumentos que permitan detectar precozmente estos hechos, así como comprender el problema de cara a plantear medidas eficaces para su prevención y tratamiento. El objetivo de este trabajo es diseñar un nuevo autoinforme, denominado Cuestionario de Ciberagresión para Adolescentes (CYBA), para evaluar en qué medida el informante ejerce agresiones a través del teléfono móvil o Internet y analizar la validez factorial y de criterio y la fiabilidad de sus puntuaciones en una muestra de adolescentes de Asturias (España). Para ello, se aplicó el CYBA a 3.148 jóvenes de 12 a 18 años, junto con tres autoinformes para medir agresión escolar offline, impulsividad y empatía. Respecto a la validez factorial, el modelo que mejor representa la estructura del CYBA es el compuesto por tres factores (suplantación, ciberagresión visual-sexual y ciberagresión verbal/exclusión) y otros cuatro indicadores de ciberagresión visual-burlas/happy slapping. Respecto a la validez de criterio, la puntuación en el CYBA correlaciona de manera positiva con agresión escolar offline e impulsividad y negativa con empatía, tres variables con las que la evidencia empírica previa indica que correlaciona la ciberagresión. La fiabilidad de las puntuaciones en cada ítem y factor del CYBA son adecuadas. Por todo ello, se concluye que el CYBA ofrece una medida válida y fiable de ciberagresión en adolescentes (AU)

Achieving a decision-making triad in adolescent sexual health care.

It is well known that adolescents delay and avoid sexual health care and fail to disclose necessary information to providers when their confidentiality is not ensured. However, it is not always clear if adolescents are psychosocially, affectively, or cognitively ready for independent decision-making. Whether confidentiality can and should be maintained necessitates that parents and providers have an understanding of adolescents' need for confidentiality. This article explores the concepts of confidentiality and consent in the context of teenage development and behaviors and addresses the complexity of the decision-making triad in adolescent sexual health care.

Making sense of adolescent decision-making: challenge and reality.

Few topics in pediatric bioethics are as vexing as decision-making. Decision-making in pediatrics presents challenges for children, parents, and physicians alike. The related, yet distinct, concepts of assent and consent are central to pediatric decision-making. Although informed consent is largely regarded as a worthwhile adult principle, assent has been, and continues to be, mired in debate. Controversial subjects include a meaningful definition of assent; how old children should be to assent; who should be included in the assent process; parental permission; how to resolve disputes between children and their parents; the relationship between assent and consent; the quantity and quality of information to disclose to children and their families; how much and what information children desire and need; the necessity and methods for assessing both children's understanding of disclosed information and of the assent process itself; reconciling ethical and legal attitudes toward assent; and finally, an effective, practical, and realistically applicable decision-making model.

Confidentiality, consent, and caring for the adolescent patient.

PURPOSE OF REVIEW: This study reviews the healthcare-related rationale for providing confidential care to adolescents, as well as the legal framework for the provision of such care. RECENT FINDINGS: Physician assurances of confidentiality increase adolescents' willingness to disclose sensitive health information, but these assurances are rarely given. Physicians may not be aware of legal minor consent guidelines or may be concerned about parental reaction to such confidential discussions. Fortunately, many parents and teens understand the importance of confidential healthcare. Adolescent consent and confidentiality laws vary from state to state, but there are federal guidelines and common law concepts that are applicable throughout the United States. The Health Insurance Portability and Accountability Act Privacy Rule also provides guidelines for confidential care to minors. Future challenges for adolescent confidentiality include ease of access to electronic medical records as well as patient (and/or parent)-controlled health records. SUMMARY: Confidentiality for adolescents has important implications for the quality provision of healthcare for this vulnerable population. Physicians and other healthcare providers must be aware of these health implications, as well as federal policies, common law, and their individual state's laws pertaining to this important topic.

Garantías de los derechos humanos a la salud de la niñez y la adolescencia en Cuba, con relación al cumplimiento de la Convención sobre los derechos del niño / - Guarrantees of human rights for the children and adolescent´s health in Cuba, in relation to the acomplishment of the Convention on the rights of children

De los principios expresados en la Declaración Universal de derechos Humanos se deriva la Convención Sobre los Derechos del Niño que se convirtió en el tratado internacional más rápidoy ampliamente aceptado por la comunidad en la historia, teniendo la importancia de garantizar lasupervivencia, protección, desarrollo y participación de los niños, niñas y adolescentes. Los derechos humanos que se recogen en la Convención son el reflejo de una serie de necesidades como es el derecho al más alto posible nivel de salud. La investigación se realizó utilizando las técnicas de revisión bibliográficas y estudio comparado. El objeto de estudio de este trabajo es analizar el cumplimiento de este derecho en Cuba, apartir de las medidas y mecanismos que el estado a establecido para lograr este objetivo.A través del desarrollo del mismo se evidencian los logros obtenidos en la salud a partir del triunfo de la revolución, sin embargo a pesar de todas las medidas adoptadas por el gobierno, todavía tenemos que seguir trabajando pues no es suficiente el conocimiento de esta Convención,ni de los programas y mecanismos establecidos para cumplimentarlos, siendo este un tema novedoso y de gran importancia, pues aún y cuando se realizan ingentes esfuerzos por la UNICEF para lograr el cumplimiento de la Convención por los estados partes, en el mundo, cada día son mayores los niños, niñas y adolescentes privados del disfrute de este derecho humano como consecuencia de los conflictos armados, el subdesarrollo, la pobreza, el hambre, la malnutrición, la prostitución y otras problemáticas sociales(AU)

[Legal and medico-legal issues in adolescent medicine. A critical review of the present regulation and legislation]. / Aspetti giuridici e medico-legali della pratica adolescentologica. Riflessioni sulla normativa e legislazione vigenti.

During the last years the Italian Government has taken many different initiatives to protect the adolescents rights to benefit from physical, psychical and social well-being. In particular, various projects concerning the promotion and the support of the school, the family, sport, mass-media, judicial and medical infrastructures, have been organised, promoted and financed. However, it is not always possible to assure a real safeguarding of teenagers rights; this especially happens because the problem concerning the autonomous capacity of minors to consent (or non consent) to the medical treatment is much debated. However, many contradictions still persist about the effective duration of the pediatric age. All the same, it must be noted that the Legislator apparently realised that not only the physical, psychological and social maturity proceed by steps, but also the legal capacity.

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. METHODS: A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. RESULTS: Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. CONCLUSIONS: This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.