Sexual matters among teenagers.

In the complex developmental period of puberty, adolescents experience biophysical changes and adapt to societal and cultural expectations of adulthood. Development of their sexuality is an important biopsychosocial change during this period that, when neglected, may result in unmet sexual and reproductive health needs. Patterns of behaviour in adolescence have repercussions across the lifespan. HEADSSS (home, education/employment/eating, activities, drugs, sexuality, sleep, suicide/depression and safety) is a systematic clinical screening tool for use with adolescents. Adolescents may view risk-seeking lifestyle patterns as appropriate behaviours, and physicians can help them recognise the risks and develop less harmful alternatives and strategies. Personal biases should not affect healthcare providers' duty to respect the rights of adolescents and ability to provide developmentally appropriate care. Healthcare professionals should be familiar with the relevant legal statutes in Singapore and refer suspected sexual abuse or violence, risk of self-harm, teenage pregnancy, newly diagnosed sexual transmitted infections or multiple risk-seeking behaviours for further evaluation and help.

[Treatment for children and adolescents with pain in Spain: data from a survey on current specialized programs]. / El tratamiento del dolor en población infantojuvenil en España: Datos de una encuesta sobre los programas especializados existentes.

OBJECTIVE: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs. This lack of information prevents an adequate evaluation of the current procedures, and hinders an adequate administration and management of these resources. The objective of this work was to study the characteristics of these units and programs for the treatment of children and adolescents with pain in Spain. METHODS: A total of 10 specialized units or specific treatment programs for pediatric pain in Spain were identified, and the person responsible was contacted. Through a self-administered online survey, information was collected on the organization of the program, the involvement in relevant fields such as research, training of professionals and the raising of awareness and visibility of the problem, the specialties involved, the type of treatments offered, the evaluation of results and the services provided. RESULTS: Of the ten units or programs contacted, eight answered the survey (80%). Pain programs for children and adolescents proved to be primarily pharmacological, also for chronic pain. They reported to promote awareness about the problem (88%), to contribute to the training of specialists (88%) and to a lesser extent to research and knowledge generation (75%). CONCLUSIONS: This survey provides valuable information on the current characteristics of specialized programs and units for the treatment of children and adolescents with pain in Spain, and can be used to propose actions that improve its current management and administration.

OBJETIVO: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o programas especializados. Esta falta de información impide una evaluación adecuada de los procedimientos vigentes y dificulta una adecuada administración y gestión de estos recursos. El objetivo de este trabajo fue conocer las características de estas unidades y programas para el tratamiento de la población infantojuvenil con dolor en España. METODOS: Se identificaron un total de 10 unidades especializadas o programas de tratamiento específicos del dolor infantil en España y se contactó con la persona responsable. A través de una encuesta autoadministrada online se recogió información sobre la organización del programa, su implicación en ámbitos relevantes como la investigación, la formación de los profesionales, la sensibilización y visibilidad del problema en la sociedad y entre los profesionales, las especialidades implicadas, el tipo de tratamientos que se ofrecen, la evaluación de resultados y los servicios prestados. Se han utilizado medias y porcentajes para describir los resultados. RESULTADOS: De las diez unidades o programas contactados, ocho contestaron a la encuesta (80%). Los programas de tratamiento del dolor infantojuvenil demostraron ser fundamentalmente farmacológicos, también en los casos de dolor crónico. Informaban de que se preocupaban por impulsar la sensibilización de los especialistas y la sociedad sobre el problema (88%), de contribuir también a la formación de especialistas (88%) y, en menor medida, de investigar y generar conocimiento (75%). CONCLUSIONES: Esta encuesta proporciona información valiosa sobre las características actuales de los programas y unidades especializadas para el tratamiento de la población infantojuvenil con dolor en España. Puede servir para proponer acciones que mejoren la gestión y administración actual.

Adolescent Access to Patient-Centered Medical Homes.

OBJECTIVES: To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups. STUDY DESIGN: Data on adolescents ages 12-17 years (n = 34 601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007. RESULTS: Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007. CONCLUSIONS: PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.

El tratamiento del dolor en población infantojuvenil en España: Datos de una encuesta sobre los programas especializados existentes / Treatment for children and adolescents with pain in Spain: data from a survey on current specialized programs

OBJETIVO: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o programas especializados. Esta falta de información impide una evaluación adecuada de los procedimientos vigentes y dificulta una adecuada administración y gestión de estos recursos. El objetivo de este trabajo fue conocer las características de estas unidades y programas para el tratamiento de la población infantojuvenil con dolor en España. MÉTODOS: Se identificaron un total de 10 unidades especializadas o programas de tratamiento específicos del dolor infantil en España y se contactó con la persona responsable. A través de una encuesta autoadministrada online se recogió información sobre la organización del programa, su implicación en ámbitos relevantes como la investigación, la formación de los profesionales, la sensibilización y visibilidad del problema en la sociedad y entre los profesionales, las especialidades implicadas, el tipo de tratamientos que se ofrecen, la evaluación de resultados y los servicios prestados. Se han utilizado medias y porcentajes para describir los resultados. RESULTADOS: De las diez unidades o programas contactados, ocho contestaron a la encuesta (80%). Los programas de tratamiento del dolor infantojuvenil demostraron ser fundamentalmente farmacológicos, también en los casos de dolor crónico. Informaban de que se preocupaban por impulsar la sensibilización de los especialistas y la sociedad sobre el problema (88%), de contribuir también a la formación de especialistas (88%) y, en menor medida, de investigar y generar conocimiento (75%). CONCLUSIONES: Esta encuesta proporciona información valiosa sobre las características actuales de los programas y unidades especializadas para el tratamiento de la población infantojuvenil con dolor en España. Puede servir para proponer acciones que mejoren la gestión y administración actual

OBJECTIVE: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs. This lack of information prevents an adequate evaluation of the current procedures, and hinders an adequate administration and management of these resources. The objective of this work was to study the characteristics of these units and programs for the treatment of children and adolescents with pain in Spain. METHODS: A total of 10 specialized units or specific treatment programs for pediatric pain in Spain were identified, and the person responsible was contacted. Through a self-administered online survey, information was collected on the organization of the program, the involvement in relevant fields such as research, training of professionals and the raising of awareness and visibility of the problem, the specialties involved, the type of treatments offered, the evaluation of results and the services provided. RESULTS: Of the ten units or programs contacted, eight answered the survey (80%). Pain programs for children and adolescents proved to be primarily pharmacological, also for chronic pain. They reported to promote awareness about the problem (88%), to contribute to the training of specialists (88%) and to a lesser extent to research and knowledge generation (75%). CONCLUSIONS: This survey provides valuable information on the current characteristics of specialized programs and units for the treatment of children and adolescents with pain in Spain, and can be used to propose actions that improve its current management and administration

Instruments for the care of pressure injury in pediatrics and hebiatrics: an integrative review of the literature / Instrumentos para cuidado de lesão por pressão na pediatria e hebiatria: revisão integrativa da literatura / Instrumentos para cuidado de lesión por presión en la pediatría y hebiatría: revisión integradora de la literatura

ABSTRACT Objective: to identify existing instruments in the scientific literature about the care of pressure injuries in pediatric and hebiatric patients. Method: an integrative review that selected 32 articles from the PubMed/Medline, LILACS, Scopus and CINAHL databases using the descriptors pressure ulcer, decubitus ulcer, pediatrics, adolescent and protocols and their equivalent terms in Portuguese and Spanish. Inclusion criteria: research articles in full, in Portuguese, English or Spanish without any temporal cut-off. The descriptive analysis was adopted to categorize the instruments found into the three domains of care: evaluative, preventive and curative. Results: 25 instruments for the care of pressure injuries in pediatric and hebiatric patients were found, with an emphasis on the Braden Q Scale being the most commonly used to assess pressure injury risk, and the protocols containing pressure injury staging guidelines developed by the National Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP). Conclusion: the scientific literature has valid and reliable instruments that can be used in nursing care practice aimed at the evaluative, preventive and curative care of pressure injuries in pediatric and hebiatric patients.

RESUMO Objetivo: identificar instrumentos existentes na literatura científica acerca do cuidado de lesão por pressão em pacientes pediátricos e hebiátricos. Método: revisão integrativa, selecionando-se 32 artigos, das bases de dados PubMed/Medline, LILACS, Scopus e CINAHL, usando os descritores lesão por pressão, úlcera de decúbito, pediatria, adolescente e protocolos, e equivalentes, nos idiomas inglês e espanhol. Critérios de inclusão: artigo de pesquisa na íntegra, nos idiomas português, inglês ou espanhol, sem delimitação temporal. Análise descritiva adotada para categorização dos instrumentos encontrados nos três domínios do cuidado: avaliativo, preventivo e curativo. Resultados: encontrados 25 instrumentos para o cuidado de lesão por pressão na pediatria e hebiatria, com destaque para escala de Braden Q, a mais utilizada para avaliação do risco de lesão por pressão, e os protocolos com diretrizes para o estadiamento da lesão, desenvolvidos pela National Pressure Ulcer Advisory Panel (NPUAP) e European Pressure Ulcer Advisory Panel (EPUAP). Conclusão: na literatura científica, há instrumentos válidos e confiáveis que podem ser usados na prática assistencial de enfermagem, voltados para os cuidados avaliativo, preventivo e curativo de lesão por pressão em pacientes pediátricos e hebiátricos.

RESUMEN Objetivo: identificar instrumentos existentes en la literatura científica acerca del cuidado de lesión por presión en pacientes pediátricos y hebiátricos. Método: revisión integradora; fueron seleccionados 32 artículos, en los idiomas inglés y español, en las bases de datos PubMed/Medline, LILACS, Scopus y CINAHL usando los descriptores lesión por presión, úlcera de decúbito, pediatría, adolescente y, también para protocolos y equivalentes. Criterios de inclusión: artículos de investigación completos, en el idioma portugués, inglés o español, sin limitación de tiempo. Se adoptó el análisis descriptivo para categorizar los instrumentos encontrados en tres dominios de cuidado: evaluativo, preventivo y curativo. Resultados: fueron encontrados 25 instrumentos para el cuidado de lesión por presión en pediatría y hebiatría, con destaque para Escala de Braden Q, que fue la más utilizada para evaluar el riesgo de lesión por presión y protocolos con directrices para el estadificación de la lesión, desarrollados por la National Pressure Ulcer Advisory Panel (NPUAP) y por el European Pressure Ulcer Advisory Panel (EPUAP). Conclusión: en la literatura científica, existen instrumentos válidos y confiables que pueden ser usados en la práctica asistencial de Enfermería, dirigidos para cuidado evaluativo, preventivo y curativo, de lesión por presión en pacientes pediátricos y hebiátricos.

Human Immunodeficiency Virus, Other Sexually Transmitted Infections, and Sexual and Reproductive Health in Lesbian, Gay, Bisexual, Transgender Youth.

Lesbian, gay, bisexual, transgender (LGBT), and questioning youth represent a diverse population who are affected by many sexual health inequities, including increased risk for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). To provide comprehensive sexual health care for LGBT youth, providers should set the stage with a nonjudgmental, respectful tone. Providers should be competent in recognizing symptoms of STIs and HIV and aware of the most up-to-date screening guidelines for LGBT youth. Sexual health visits should also focus on prevention, including safer sex practices, HIV pre-exposure and post-exposure prophylaxis, family planning, and immunization for hepatitis and human papillomavirus.

Substance Abuse Prevention, Assessment, and Treatment for Lesbian, Gay, Bisexual, and Transgender Youth.

Knowing how to manage substance abuse in all youth is an important aspect of pediatric care, including providing clinically appropriate anticipatory guidance, monitoring, assessment, and treatment. Although most lesbian, gay, bisexual, and transgender (LGBT) youth do not abuse substances, as a group they experience unique challenges in self-identity development that put them at an increased risk for substance abuse. This article addresses prevention and management of substance use in LGBT youth relevant to pediatrics and allied professions as an aspect of their overall health care. It reviews basic information about substance abuse in youth and special considerations for LGBT youth.

Adolescent health in Asia: insights from India.

Adolescents living in the Indian subcontinent form a significant proportion of the general population. India is home to 236 million adolescents, who make up one-fifth of the total population of India. Adolescent health is gradually considered an important issue by the government of India. Awareness is increasing about adolescent needs. Health care professionals in particular are becoming more interested in the specific needs of adolescent age. Adolescent medicine as a subspecialty of pediatrics has also gained importance gradually over the last decade. In a hospital setting, adolescent-specific needs are met, albeit not in a uniform manner in all the health centers. After having been trained in adolescent medicine in India and abroad, I present this paper as a bird's eye view of the practice of adolescent health and medicine in India.

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.

Adolescent health care education and training: insights from Israel.

There is a growing need for health care professionals to extend their knowledge in adolescent health care. Formal training curricula in adolescent medicine have been established in the United States, Canada, and Australia, yet many other countries have developed shorter training programs to enable interested physicians to further pursue knowledge and practical experience in delivering improved quality health care for adolescents. The Israeli experience in building an infrastructure that allows students and physicians to learn about adolescent medicine and to train in the field is described. It includes a series of lectures and seminars for medical students during medical school and at the clinical rotations in pediatric wards; the development of hospital-based and community-based multidisciplinary adolescent health services where residents can practice adolescent health care; a 3-year diploma course in adolescent medicine for specialists in pediatrics and family medicine; mini courses in adolescent medicine for pediatricians and family practitioners working in community settings; and a simulated patient-based program regarding communication with adolescents, aimed for all professional levels - medical students, residents, and specialists. This infrastructure has been developed to create a leading group of physicians, who are able to operate adolescent clinics and to teach adolescent medicine. Recently, a formal fellowship program in adolescent medicine has been approved by the Scientific Council of the Israel Medical Association. The Israeli experience described here could be applied in countries, where formal training programs in adolescent health care are not yet established.

Accreditation of Adolescent Medicine as a pediatric sub-specialty: the Canadian experience and lessons learned.

The Royal College of Physicians and Surgeons of Canada (Royal College) has an extensive process for recognizing new specialties and subspecialties. Among other requirements, the process requests that the applicants demonstrate that sufficient scientific breadth and depth exists within the proposed field, that a unique field of clinical practice exists, and that there is a societal need for individuals with this distinct area of specialization. In 2004, a group of adolescent medicine specialists from across Canada started the application process for the field to become an accredited pediatric subspecialty. A 3-year process was undertaken to demonstrate the need for accreditation of this new and emerging discipline. In 2007, Adolescent Medicine became the 63rd discipline and a sub-specialty of Pediatrics. This paper provides an overview of the process that led to the accreditation of Adolescent Medicine by the Royal College and offers insights into the lessons learned from this Canadian experience.

Adolescent and young adult medicine in Australia and New Zealand: towards specialist accreditation.

In Australia and New Zealand, a critical mass of academic and clinical leadership in Adolescent Medicine has helped advance models of clinical services, drive investments in teaching and training, and strengthen research capacity over the past 30 years. There is growing recognition of the importance of influencing the training of adult physicians as well as paediatricians. The Royal Australasian College of Physicians (RACP) is responsible for overseeing all aspects of specialist physician training across the two countries. Following advocacy from adolescent physicians, the RACP is advancing a three-tier strategy to build greater specialist capacity and sustain leadership in adolescent and young adult medicine (AYAM). The first tier of the strategy supports universal training in adolescent and young adult health and medicine for all basic trainees in paediatric and adult medicine through an online training resource. The second and third tiers support advanced training in AYAM for specialist practice, based on an advanced training curriculum that has been approved by the RACP. The second tier is dual training; advanced trainees can undertake 2 years training in AYAM and 2 years training in another area of specialist practice. The third tier consists of 3 years of advanced training in AYAM. The RACP is currently seeking formal recognition from the Australian Government to have AYAM accredited, a process that will be subsequently undertaken in New Zealand. The RACP is expectant that the accreditation of specialist AYAM physicians will promote sustained academic and clinical leadership in AYAM to the benefit of future generations of young Australasians.

The foundations of interdisciplinary fellowship training in adolescent medicine in the United States.

The field of adolescent medicine, having developed from the specialty of Pediatrics, encompasses a holistic and developmental approach from its very origin. While its foundations were in medicine, early leaders in the field emphasized the importance of mental health care as well as nutrition, public health, and social justice. As the specialty became further established in the US with the creation of an academic society, board certification and training program accreditation, the interdisciplinary nature of adolescent medicine practice and training became formalized. This formal recognition brought with it strict guidelines with regards training and board certification. Despite the often Byzantinian training requirements, an interdisciplinary approach forms the core of adolescent medicine practice, and the incorporation of interdisciplinary training is a necessity for graduate medical education programs in the field of adolescent medicine.

LEAH interdisciplinary training program.

This article describes the Leadership Education in Adolescent Health (LEAH) interdisciplinary training program in the United States. The Maternal and Child Health Bureau authorized by legislation provides monies to train leaders in adolescent health through a competitive grant process. Currently, seven academic medical centers have funding to provide leadership in adolescent health (LEAH) training in five core disciplines: medicine, nursing, psychology, social work and nutrition. LEAH training programs both ensure high clinical competence in core disciplines serving adolescents and prepare trainees for leadership positions in adolescent health and public health care realms. Together, these programs trained almost 1000 long-term trainees across these five disciplines, and graduates from these programs are working in 45 of the 50 states within the United States. About 90% of these graduates are working with maternal and child/adolescent health populations, and almost all have held leadership positions in the areas of public health, advocacy, public policy, academic medical centers and/or clinical care settings.

A different training model for adolescent medicine: a PhD program in Turkey, where adolescent medicine is not currently a sub-specialty at this stage.

Adolescent medicine is currently not a certified subspecialty by the Ministry of Health in Turkey. Until recently, no subspecialty education was available for pediatricians interested in pursuing a career in this field. To compensate for the lack of training opportunities in the field, to meet the needs of adolescents and to increase research and strengthen scientific knowledge in the area of adolescent medicine, a doctoral program was established in 2004 by the Division of Adolescent Medicine under the Institute of Child Health at Hacettepe University in Ankara. This paper discusses the opportunities provided by the program, describing the pros and cons of such a course and what the program aims to achieve. This unique program provides pediatricians with extended postgraduate, subspecialty education in adolescent health care. We believe that the adolescent medicine PhD program at Hacettepe University could be a model for educating health care professionals in this field in other countries where there are not established fellowship programs.

The globalization of training in adolescent health and medicine: one size does not fit all.

Adolescent medicine across the globe is practiced within a variety of healthcare models, with the shared vision of the promotion of optimal health outcomes for adolescents. In the past decade, there has been a call for transformation in how health professionals are trained, with recommendations that there be adoption of a global outlook, a multiprofessional perspective and a systems approach that considers the connections between education and health systems. Many individuals and groups are now examining how best to accomplish this educational reform. There are tensions between the call for globally accepted standards of education models and practice (a one-size fits all approach) and the need to promote the ability for education practices to be interpreted and transformed to best suit local contexts. This paper discusses some of the key considerations for 'importing' training program models for adolescent health and medicine, including the importance of cultural alignment and the utilization of best evidence and practice in health professions education.

Adolescent health in the Caribbean region: insights from the Jamaican experience.

Adolescent health in Jamaica and the wider English-speaking Caribbean has over the past three decades advanced in achieving improved healthcare services for adolescents. The path taken to achieve success thus far is reviewed - including a historical perspective on the services offered, revision of the relevant policy and legislation frameworks, improved service delivery through education and training of relevant stakeholders and providers, improved youth participation, and sustained involvement of advocates.

The health of Swiss adolescents and its implications for training of health professionals in Switzerland.

Swiss adolescents generally enjoy satisfying life conditions. Nonetheless, violence, suicide and mental health are the main concerns together with injuries, chronic conditions and eating disorders. Adolescents still face barriers to access the care they need. Adequate training can improve practitioners' skills when dealing with adolescents. The last two decades have seen the development of innovative adolescent health units and networks in various regions of Switzerland as well as research and public health programmes. Training programmes in adolescent health (continuous medical education, post-graduate or pre-graduate) for physicians and nurses are developing but still patchy in Switzerland. Adolescent health is not a sub-specialty as such. Efforts have to be made in order to link with professional associations and institutions to implement adolescent health curricula more efficiently.

The North American Society for Pediatric and Adolescent Gynecology Fellowship Family Tree.

STUDY OBJECTIVE: To create a family tree to chronicle the proliferation of our specialty through fellowships (formal and informal) within the pediatric and adolescent gynecology practice and among the membership of the North American Society for Pediatric and Adolescent Gynecology (NASPAG). This historical project was undertaken as a way to demonstrate NASPAG's rich sense of heritage and community. The tree is meant to be a dynamic project, a living document, changing and expanding as this field of medicine grows, and offers a form of institutional memory for NASPAG. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: Questionnaires were sent out to all current NASPAG members via e-mail (and the list-serve) and were available at the 2014 NASPAG Annual Clinical and Research Meeting. Data from the questionnaires were recorded within GRAMPS 3.4.8, software used to create a family tree. MAIN OUTCOME MEASURES AND RESULTS: The result of the project was an elegant and intricate tree, containing 379 "family members" including physicians who specialize in pediatric and adolescent gynecology, adolescent medicine, reproductive endocrinology and infertility, and pediatric endocrinology. CONCLUSION: The family tree, which shows how one mentor might train multiple trainees and how past trainees later become mentors, highlights the value of physicians who take on supervisory and educational roles and the existence of comprehensive and inspirational training programs.