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1.
PLoS One ; 14(2): e0211116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30779800

RESUMO

OBJECTIVE: The rapid proliferation of machine learning research using electronic health records to classify healthcare outcomes offers an opportunity to address the pressing public health problem of adolescent suicidal behavior. We describe the development and evaluation of a machine learning algorithm using natural language processing of electronic health records to identify suicidal behavior among psychiatrically hospitalized adolescents. METHODS: Adolescents hospitalized on a psychiatric inpatient unit in a community health system in the northeastern United States were surveyed for history of suicide attempt in the past 12 months. A total of 73 respondents had electronic health records available prior to the index psychiatric admission. Unstructured clinical notes were downloaded from the year preceding the index inpatient admission. Natural language processing identified phrases from the notes associated with the suicide attempt outcome. We enriched this group of phrases with a clinically focused list of terms representing known risk and protective factors for suicide attempt in adolescents. We then applied the random forest machine learning algorithm to develop a classification model. The model performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS: The final model had a sensitivity of 0.83, specificity of 0.22, AUC of 0.68, a PPV of 0.42, NPV of 0.67, and an accuracy of 0.47. The terms mostly highly associated with suicide attempt clustered around terms related to suicide, family members, psychiatric disorders, and psychotropic medications. CONCLUSION: This analysis demonstrates modest success of a natural language processing and machine learning approach to identifying suicide attempt among a small sample of hospitalized adolescents in a psychiatric setting.


Assuntos
Comportamento do Adolescente , Adolescente Hospitalizado/psicologia , Aprendizado de Máquina , Processamento de Linguagem Natural , Ideação Suicida , Adolescente , Algoritmos , Criança , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Massachusetts , Unidade Hospitalar de Psiquiatria , Psicologia do Adolescente , Tentativa de Suicídio/psicologia , Adulto Jovem
2.
Psychol Serv ; 16(1): 48-57, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30475046

RESUMO

Children with pediatric injury and their parents are at risk for developing posttraumatic stress disorder (PTSD). Although challenging to implement, standardized screening for risk of developing PTSD can identify families most at risk. The current retrospective, chart review study evaluated the implementation of a clinical program that integrated screening for risk of PTSD into standard care for youth admitted to a Level I pediatric trauma center due to injury. Advanced practice nurses administered the Screening Tool for Early Predictors of PTSD (STEPP), a brief screen that evaluates risk of developing PTSD for injured children (ages 8-17 years) and their parents. Positive parent or child STEPPs prompted a referral to psychology for an inpatient consultation. Data were collected via review of electronic medical records and trauma program registry, including demographic, injury, and admission information, completion of and result on the STEPP, and completion of a psychology consultation. During the 2.5 year study period, 1,153 youth (birth-17 years) were admitted due to injury. Among those eligible for the STEPP (i.e., ≥8 years; N = 562), 67% completed the STEPP. Among those who completed the STEPP, 25% had positive parent or child screens and 68% of these completed an inpatient psychology consultation. Standardized screening was related to significantly higher use of inpatient psychology services compared with a control sample not eligible for screening (i.e., <8 years). STEPP scores varied by demographic, admission and injury factors. Results suggest standardized screening is feasible and improves reach of trauma-informed care. Barriers and facilitators of this screening program are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Adolescente Hospitalizado/psicologia , Criança Hospitalizada/psicologia , Desenvolvimento de Programas , Sistema de Registros , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Centros de Traumatologia , Ferimentos e Lesões/psicologia , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/etiologia , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/terapia
3.
Nurs Ethics ; 26(3): 728-737, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-28805113

RESUMO

BACKGROUND: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents' recovery. However, many studies have been conducted on exploring the concept of the patients' dignity from the adult patients and fewer studies still have explored the dignity of young people. OBJECTIVE: This study explores the hospitalized adolescents' perception about dignity. RESEARCH DESIGN: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents' dignity. PARTICIPANTS AND RESEARCH CONTEXT: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). ETHICAL CONSIDERATIONS: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. FINDINGS: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. DISCUSSION AND CONCLUSION: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent's identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses.


Assuntos
Adolescente Hospitalizado/psicologia , Percepção , Pessoalidade , Adolescente , Comportamento do Adolescente/psicologia , Criança , Ética em Enfermagem , Feminino , Humanos , Comportamento de Doença , Pacientes Internados/psicologia , Masculino , Pesquisa Qualitativa
4.
J Nurs Res ; 27(2): e14, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30102645

RESUMO

BACKGROUND: The feeling of safety makes an important contribution to the sense of well-being and quality of care for hospitalized adolescents, who are at a higher risk of feeling unsafe. Feeling unsafe during hospitalization may have a negative impact on recovery. Nurses must be sensitive to the possibility that patients feel unsafe, even in the absence of obvious direct physical threat. PURPOSE: This study explores the experiences of hospitalized adolescents to obtain an understanding of psychological safety. METHODS: A qualitative study using unstructured interviews was conducted to explore the sense of psychological safety of hospitalized adolescents aged 12-18 years and registered in a general medical or surgical pediatric unit. Purposive sampling was used to recruit new qualified participants until data saturation was reached (N = 16). RESULTS: Psychological safety is reflected by the four themes of receiving comprehensive support, protection of human dignity, relaxing environment, and attempts to adapt. CONCLUSIONS: Hospitalized adolescents stated that healthcare services should provide comprehensive support in a relaxing environment that allows them to retain their human dignity and that elicits feelings of psychological safety.


Assuntos
Adolescente Hospitalizado/psicologia , Segurança do Paciente/normas , Adolescente , Comportamento do Adolescente/psicologia , Adolescente Hospitalizado/estatística & dados numéricos , Criança , Emoções , Feminino , Humanos , Entrevistas como Assunto/métodos , Irã (Geográfico) , Masculino , Segurança do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Apoio Social , Espiritualidade
5.
Rev Gaucha Enferm ; 39: e20170290, 2018 Aug 02.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30088608

RESUMO

OBJECTIVE: To analyze the bond in social support delivery by a multidisciplinary team to families during the hospital stay of children/adolescents with chronic disease. METHOD: Qualitative research, conducted in the pediatric unit of a public hospital in Paraíba State, Brazil, from November 2012 to July 2013, involving fourteen health professionals, by means of a semi-structured interview. The data were subjected to thematic analysis. RESULTS: The bond between the team and the family is promoted by dialogue and listening, which are recognized sources of social support. The encountered difficulties that interfered with the delivery of social support were weakness in team-family communication and interaction, gaps in the organization of the work process and lack of hospital infrastructure. Possible approaches to overcome these obstacles were follow-up beyond hospital discharge and a stronger team-family bond. CONCLUSION: Satisfying social support has an influence on coping with chronic disease in children and adolescents, and its proper delivery relies upon bonding and embracement.


Assuntos
Doença Crônica/psicologia , Apego ao Objeto , Equipe de Assistência ao Paciente , Relações Profissional-Família , Apoio Social , Adolescente , Adolescente Hospitalizado , Adulto , Atitude do Pessoal de Saúde , Brasil , Criança , Criança Hospitalizada , Barreiras de Comunicação , Feminino , Unidades Hospitalares , Hospitais Públicos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pediatria , Pesquisa Qualitativa
6.
Pediatr Ann ; 47(8): e323-e327, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30102756

RESUMO

Youth admitted to pediatric hospitals face a variety of emotional challenges throughout their stay. In addition to feeling compromised by their acute medical condition, managing the requirements imposed by hospital care can intensify the potential for behavioral dysregulation. Even meeting basic behavioral expectations often requires children to be highly vulnerable, uncomfortable, and in pain, having to trust a parade of people routinely delivering aversive interventions, all in the context of overwhelmed caregivers. Behavioral medicine approaches are thus essential for supporting adaptive coping to optimize emotional and pathophysiological recovery. Clinical implementation requires integration of emotional and behavioral health initiatives into medical services across the broadest of disciplines with hospital-wide vigilance to safety risks. Providers can support behavioral resiliency by nurturing youth who are hospitalized to become increasingly active agents in their care while bolstering the consistency of their behavioral expectations through effective communication and an empathic treatment approach tailored to their socioemotional needs. [Pediatr Ann. 2018;47(8):e323-e327.].


Assuntos
Adolescente Hospitalizado/psicologia , Criança Hospitalizada/psicologia , Transtornos Mentais/terapia , Serviços de Saúde Mental , Adaptação Psicológica , Adolescente , Criança , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Relações Pais-Filho , Resiliência Psicológica
7.
Rev. pesqui. cuid. fundam. (Online) ; 10(3): 663-668, jul.-set. 2018. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-906260

RESUMO

Objetivo: Compreender as percepções dos adolescentes frente à hospitalização e analisar como os adolescentes vivenciam o processo de hospitalização. Métodos: estudo de campo com abordagem qualitativa, método descritivo, utilizando a técnica de entrevista com perguntas semiestruturadas, desenvolvido em uma enfermaria especializada em saúde do adolescente em um hospital universitário no Rio de Janeiro. O período de coleta de dados desenvolveu-se de fevereiro a abril de 2016, sendo entrevistados 14 adolescentes, com a faixa etária de 12 a 18 anos. Resultados: a partir das unidades de registros que foram agrupadas, definiram-se duas categorias frente à hospitalização: repercussões do processo de hospitalização na vida dos adolescentes e formas de enfrentamento durante a hospitalização. Conclusão: conclui-se que os profissionais de enfermagem precisam conhecer e compreender a realidade do adolescente para oferecer um cuidado capaz de fazer com que eles enfrentem melhor o adoecimento e a hospitalização


Objetivo: Conocer las percepciones de los adolescentes en el hospital y examinar cómo los adolescentes experimentan el proceso de hospitalización. Métodos: Estudio de campo con enfoque cualitativo, método descriptivo, utilizando la técnica de entrevista con preguntas semiestructuradas, desarrollado en una sala especializada para la salud de los adolescentes en un hospital universitario de Río de Janeiro. El período de recolección de datos se desarrolló entre febrero y abril de 2016, y entrevistó a 14 adolescentes, el grupo de edad de 12-18 años. Resultados: A partir de los registros que se han agrupado unidades, se definieron dos categorías frente al hospital: el impacto proceso de hospitalización en la vida de los adolescentes y formas de hacer frente durante la hospitalización. Conclusión: se concluye que los profesionales de enfermería deben conocer y comprender la realidad de los adolescentes para proporcionar atención puede hacer que se enfrentan mejor la enfermedad y la hospitalización


Objective: The study's aim was to understand the adolescents' perceptions regarding hospitalization and also to analyze how adolescents experience the hospitalization process. Methods: It is a field study with a qualitative approach and descriptive method, which has used the interview technique with semi-structured questions, developed in a specialized nurses' ward in a university hospital in Rio de Janeiro, Brazil. Data collection period lasted from February to April 2016, where 14 adolescents within age group from 12 to 18 years old were interviewed. Results: From the grouped record units obtained, two categories were defined in relation to hospitalization, as follows: repercussions of the hospitalization process on adolescents' lives and forms of coping during hospitalization. Conclusion: It is concluded that nursing professionals need to know and understand the reality of the adolescent in order to offer a care capable of making them able to face both illness and hospitalization processes in a better way


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adolescente Hospitalizado/psicologia , Cuidados de Enfermagem/psicologia , Cuidados de Enfermagem/estatística & dados numéricos
8.
Psychiatr Serv ; 69(8): 910-918, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29852825

RESUMO

OBJECTIVE: The study described rates and characteristics of U.S. children hospitalized with a behavioral (mental or substance use) disorder. METHODS: This cross-sectional analysis of data from the 2012 Kids' Inpatient Database included 483,281 hospitalizations in general and children's hospitals of persons under age 21 with a primary or secondary behavioral diagnosis. RESULTS: The admission rate with any behavioral diagnosis was 5.5 per 1,000 children in the U.S. population, with 2.9 having a primary behavioral diagnosis. Common primary diagnoses included depression (34%), other mood (31%), psychotic (9%), and substance use (7%) disorders. The most common behavioral diagnoses secondary to a primary diagnosis that is not behavioral were depression (26%), attention-deficit disorder (26%), and substance use disorders (22%). Suicide or self-harm was rarely the primary diagnosis (.1%) but complicated 12% of admissions with a primary behavioral diagnosis. Variations in admissions (per 1,000 children in the U.S. population) with a primary behavioral diagnosis were noted by race-ethnicity (blacks, 3.2; whites, 2.9; and Hispanics, 1.4), insurance (public, 2.9; private, 2.0), and geographic region. Fifty-nine of every 1,000 peripartum admissions in the 12-20 age group had a secondary behavioral diagnosis. Patients with behavioral comorbidities were more likely to be transferred to another facility (8.0% versus 2.2%, p<.001). Behavioral disorders comorbid to nonbehavioral disorders increased length of stay (4.3 versus 3.3 days, p<.001) and costs ($12,742 versus $9,929, p<.001). CONCLUSIONS: Nearly 500,000 pediatric admissions in 2012 included behavioral disorders. Comorbidities were associated with longer stays and an estimated $1.36 billion additional annual costs, which were disproportionately borne by public insurance.


Assuntos
Hospitalização/economia , Hospitais Gerais/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adolescente , Adolescente Hospitalizado , Distribuição por Idade , Criança , Criança Hospitalizada , Pré-Escolar , Comorbidade , Custos e Análise de Custo , Estudos Transversais , Bases de Dados Factuais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Transtornos Mentais/economia , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto Jovem
9.
Clin Child Psychol Psychiatry ; 23(4): 644-662, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29895179

RESUMO

This article explores some core findings from a qualitative investigation of parents' experiences of their child's treatment in an adolescent mental health service in Sydney, Australia. In particular, the research question was, "How does parents' involvement in the child/adolescent's treatment influence their perception of how they can be helpful in their child's recovery?" The theme of parent hope emerged from the broad qualitative exploration of parent's experience of their involvement in their adolescent's intensive treatment program. A purposive sample of 14 sets of parents participated, being interviewed at admission, discharge, and 6 months following their adolescent's discharge. A continuum of high, moderate, and low levels of hope were evident in this parent sample 6 months after their treatment involvement. The strongly emergent theme was the relationship between parents' hope and agency/self-efficacy. Parents who remained more passive in expecting expert helpers to fix their child experienced reduced hope months after finishing the program. When parents positively changed their interaction with their child, they felt a more sustained hopefulness. These findings generate the hypothesis that if parents are actively involved in changing themselves as part of their child's treatment, they experience increased hope and effectiveness in contributing to their child's recovery.


Assuntos
Adolescente Hospitalizado/psicologia , Esperança , Transtornos Mentais/psicologia , Pais/psicologia , Autoeficácia , Adolescente , Serviços de Saúde do Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental
10.
Clin Child Psychol Psychiatry ; 23(4): 582-591, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29781293

RESUMO

The practice of mindfulness has long been incorporated into psychotherapy. Research on the therapeutic benefits of mindfulness exists within adult populations, and emerging empirical evidence demonstrates the benefit of such practices in the treatment of adolescents in both clinical and non-clinical settings. However, there are extremely limited data on the practice of mindfulness with adolescents in a psychiatric hospital. The iMatter ( Improve Mindful ATTention, Enhance Relaxation) group is a manualized program developed to provide adolescents on a short-term psychiatric inpatient unit with an opportunity to learn and practice relaxation strategies, mindfulness exercises, and simple yoga poses. Mindfulness skills are taught in the context of the group and include self-observation of thoughts and feelings, breathing exercises, self-validation of one's experience, loving-kindness toward self, non-judgmental stance toward self, and acceptance and observation of change within self. Participants included 65 adolescents aged 13-17 years ( M = 15.06, standard deviation ( SD) = 1.34) who took part in at least one session of the iMatter intervention. Improvements in self-reported mood were evident following participation in a mindfulness group. Also, participants' heart rate significantly decreased following participation in two groups. Future directions include improved integration of mindfulness into the milieu and other unit programming. Furthermore, comparing self-reported mood and physiological measures from this sample to findings obtained for other unit groups will further clarify the impact of the iMatter intervention.


Assuntos
Adolescente Hospitalizado , Transtornos Mentais/terapia , Atenção Plena/métodos , Psicoterapia de Grupo/métodos , Adolescente , Feminino , Humanos , Masculino , Unidade Hospitalar de Psiquiatria
11.
Clin Pediatr (Phila) ; 57(11): 1286-1293, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29732921

RESUMO

Hospitalized children and adolescents/young adults (AYA) frequently have mental health concerns that may be addressed by consulting psychology. We examined demographic, medical, referral, intervention, and disposition differences between children (≤11 years) and AYA referred for a psychology consult at a pediatric hospital (N = 1091). Referred AYA were more likely to be female, have shorter lengths of stay, and repeat psychology consults. Children were more likely to be referred for anxiety or feeding; AYA were more often referred for depression, pain, somatic complaints, or maladjustment. AYA were more often the target of intervention, receiving cognitive behavioral or problem-focused coping interventions, and more often recommended for psychological follow-up. AYA present unique medical and psychological challenges when hospitalized. Understanding these challenges will help providers improve the care and treatment of AYA. Academic training and future research recommendations are provided.


Assuntos
Adolescente Hospitalizado/psicologia , Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Adaptação Psicológica , Adolescente , Adolescente Hospitalizado/estatística & dados numéricos , Adulto , Criança , Terapia Cognitivo-Comportamental , Bases de Dados Factuais , Feminino , Hospitalização , Hospitais Pediátricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Transtornos Mentais/diagnóstico , Fatores Sexuais , Adulto Jovem
12.
Pediatrics ; 141(5)2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29626163

RESUMO

What should physicians do when an adolescent wishes to risk his physical health and leave the hospital to attend the funeral of his late father? What if the young man's mother, and only remaining guardian, both supports and encourages such a decision? In this Ethics Rounds discussion, we examine the legality, morality, and safety of discharging a minor under such conditions.


Assuntos
Adolescente Hospitalizado/psicologia , Tomada de Decisões/ética , Ética Institucional , Rituais Fúnebres/psicologia , Cooperação do Paciente/psicologia , Alta do Paciente , Adolescente , Serviços de Proteção Infantil/ética , Pai , Humanos , Masculino , Neurite Óptica/complicações , Neurite Óptica/diagnóstico por imagem , Neurite Óptica/terapia , Medição de Risco , Resultado do Tratamento
13.
Cancer Med ; 7(5): 1750-1755, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29573197

RESUMO

Objectives were to describe any bothersome symptom and severely bothersome symptoms in inpatient children with cancer and hematopoietic stem cell transplant (HSCT) recipients. We included children 8-18 years of age with cancer or HSCT recipients who were receiving active treatment for cancer, admitted to hospital, and expected to be in hospital 3 days later. We administered the self-report Symptom Screening in Pediatrics Tool (SSPedi). We described those who identified any degree of symptom bother (at least "a little") and those who rated the degree of bother as severe ("a lot" or "extremely"). Factors associated with severe symptoms and total SSPedi scores were examined using multiple logistic and linear regression. Among the 302 patients, 298 (98.7%) reported having any bothersome symptom and 181 (59.9%) had at least one severely bothersome symptom. In multiple regression, older children were significantly more likely to have at least one severely bothersome symptom (15-18 and 11-14 years vs. 8-10 years; P = 0.008) and to have higher total SSPedi scores (P = 0.0003). Those with relapsed disease were more likely to have at least one severely bothersome symptom (odds ratio 2.1, 95% confidence interval 1.1-4.3; P = 0.037) and HSCT recipients were more likely to have higher symptom scores (ß = 3.48, standard error = 1.6; P = 0.030). Almost all children receiving cancer therapies experience bothersome symptoms and 60% have at least one severely bothersome symptom. Older children experienced more severely bothersome symptoms and higher symptom scores. Future studies should follow children longitudinally to better understand the symptom trajectory and should institute interventions to manage symptoms.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Neoplasias/diagnóstico , Avaliação de Sintomas/métodos , Adolescente , Adolescente Hospitalizado , Canadá , Criança , Criança Hospitalizada , Detecção Precoce de Câncer , Feminino , Humanos , Modelos Logísticos , Masculino , Psicometria , Autorrelato , Estados Unidos
14.
Hosp Pediatr ; 8(4): 187-193, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29599198

RESUMO

BACKGROUND AND OBJECTIVES: Youth carry a disproportionate burden of new HIV infections. With our study, we aimed to characterize HIV testing experiences among adolescents and young adults admitted to a children's hospital that is located in a high HIV-prevalent community and implemented routine HIV testing for all patients ≥13 years of age. METHODS: A total of 120 patients aged 13 to 24 years old who were admitted to our hospital and had a documented offer of routine HIV testing on admission were invited to complete a self-administered survey that asked about sex, race and/or ethnicity, HIV risk behaviors, and attitudes toward routine HIV testing in the hospital. Date of birth, admission diagnosis, and verification of HIV testing and results were collected by chart review. RESULTS: Study participants (N = 99) were 17.4 ± 2.3 years old, 52% female, 47% Hispanic, and 29% African American. Additional characteristics include the following: 65% had previous sexual activity, 11% had a history of sexually transmitted infections, and 12% were worried about their risk for HIV. Forty-seven percent of participants accepted HIV testing, with older patients (P < .01) and those reporting previous sexual activity (P < .01) and a previous HIV test (P < .01) being more likely to accept testing. A total of 96% of participants agreed that the hospital is a good place to offer HIV testing. CONCLUSIONS: Our findings support offering routine HIV testing to youth admitted to children's hospital. Given the high incidence of new and undiagnosed HIV infections among youth, additional venues for HIV testing are essential.


Assuntos
Adolescente Hospitalizado/psicologia , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Comportamento Sexual/estatística & dados numéricos , Adolescente , Estudos Transversais , Grupos Étnicos , Feminino , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estados Unidos/epidemiologia , Adulto Jovem
15.
Hosp Pediatr ; 8(4): 179-186, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29588345

RESUMO

OBJECTIVES: To determine the frequency of sexual history taking and the associated characteristics of hospitalized adolescents in the pediatric hospitalist service. METHODS: A retrospective chart review of adolescents 14 to 18 years old who were admitted to the pediatric hospitalist service at an urban, academic children's hospital in the Northeast from 2013 to 2015 was conducted. Repeat admissions, admissions to specialty services, and charts that noted impairment because of psychosis, cognitive delay, or illness severity were excluded. For charts that met the criteria, the admission history and physical was carefully reviewed for a notation of sexual history. For those with documentation, sexual activity status and a risk level assessment were recorded. Patient demographics and admission characteristics were extracted. χ2 tests and logistic regression were used to examine differences between those with sexual history and those without. RESULTS: A total of 752 charts met the criteria for inclusion. The majority of adolescents were girls (n = 506; 67.3%); the mean age was 15.7 years (SD = 1.2). Girls had 2.99 (95% confidence interval [CI] 2.18-4.11) higher odds of documentation than boys, and older adolescents had 1.41 (95% CI 1.03-1.91) higher odds than younger adolescents. Documentation did not differ significantly on the basis of admission type (medical or psychiatric), admission time, patient race and/or ethnicity, or provider gender. Among those with a documented sexual history, risk-level details were often omitted. CONCLUSIONS: Sexual history taking does not occur universally for hospitalized adolescents. Girls were screened more often than boys despite similar rates of sexual activity. The inpatient admission may be a missed opportunity for harm-reduction counseling and adherence to sexually transmitted infection testing guidelines.


Assuntos
Adolescente Hospitalizado/estatística & dados numéricos , Documentação , Fidelidade a Diretrizes , Programas de Rastreamento/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Adolescente , Adolescente Hospitalizado/psicologia , Aconselhamento , Feminino , Humanos , Masculino , Estudos Retrospectivos , Comportamento Sexual/psicologia
16.
Mediciego ; 24(1)marz.2018. tab
Artigo em Espanhol | CUMED | ID: cum-71201

RESUMO

Introducción: el principal problema de la adolescencia son las prácticas, comportamientos y conductas de riesgo que ocasionan morbilidad crítica, discapacidad y muerte.Objetivo: describir la morbilidad y las conductas de riesgo en los adolescentes que ingresaron en las salas de miscelánea durante el año 2016.Método: se realizó un estudio descriptivo transversal en 146 adolescentes que ingresaron en las salas de miscelánea del Hospital General de Ciego de Ávila.Resultados: el intento suicida fue la primera causa de morbilidad (39,73 por ciento). Solo 35,62 por ciento acudieron en primera instancia al consultorio médico de la familia. Respecto de la participación en las actividades del programa, 84,93 por ciento no asisten a la consulta de adolescentes, 86,30 por ciento refieren no recibir visitas de terreno y 91,78 por ciento no participan en el club de adolescentes. El consumo de café fue el hábito tóxico más frecuente (52,05 por ciento). Respecto a las relaciones sexuales, 50,68 por ciento refirieron que las practican y de ellos, solo 75,68 por ciento se protegen. El 91,78 por ciento recibieron información sobre educación sexual.Conclusiones: el intento suicida y la sospecha de dengue fueron las causas de mayor morbilidad en los adolescentes. El hospital como segundo nivel de atención a la salud fue la instancia donde primero acudieron. El consumo excesivo de café fue el hábito tóxico que predominó. La participación en las actividades del Programa Nacional de Atención Integral a la Salud de Adolescentes fue baja. La mayoría de los adolescentes recibieron educación sexual(AU)


Introduction: the main problem of adolescence are the practices, behaviors and risk behaviors that cause critical morbidity, disability and death.Objective: to describe morbidity and risk behaviors in adolescents who entered the miscellaneous rooms during the year 2016.Method: a cross-sectional descriptive study was carried out in 146 adolescents who entered the miscellaneous rooms of the General Hospital of Ciego de Ávila.Results: the suicide attempt was the first cause of morbidity (39,73 percent). Only 35,62 percent went to the family doctor's office. In the participation of the activities of the program, 84,93 percent do not attend the consultation of adolescents, 86,30 percent report not receiving field visits and 91,78 percent do not participate in the adolescent club. Coffee consumption was the most common toxic habit (52,05 percent). Regarding sexual relations, 50,68 percent reported that they practice them and of them, only 75,68 percent are protected. 91,78 percent received information about sex education.Conclusions: the suicide attempt and the suspicion of dengue were the causes of greater morbidity in adolescents. The hospital as the second level of health care was the one where they first went. Excessive coffee consumption was the toxic habit that predominated. Participation in the activities of the National Program of Comprehensive Health Care for Adolescents was low. The majority of adolescents received sex education(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adolescente Hospitalizado , Dengue , Tentativa de Suicídio , Comportamento Perigoso , Estudos Transversais , Epidemiologia Descritiva
17.
J Appl Res Intellect Disabil ; 31(5): 792-803, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29336507

RESUMO

BACKGROUND: The need to review health service provision for children and young people (CYP) with disabilities and their families in the United Kingdom has been expressed in multiple reports: the most consistent message being that services need to be tailored to meet their individual needs. Our aim was to understand the hospital-related needs and experiences of CYP with intellectual disabilities. METHOD: An ethnographic study of a neurosciences ward and outpatient department was conducted within a paediatric tertiary hospital setting. RESULTS: Five themes, developed using the acronym LEARN, explained what is important to CYP with intellectual disabilities in hospital: (i) little things make the biggest difference, (ii) eliminate unnecessary waiting, (iii) avoid boredom, (iv) routine and home comforts are key and (v) never assume. CONCLUSIONS: It is imperative that the present authors continue to challenge the idea that it is acceptable to exclude CYP with intellectual disabilities from research because of their inability to participate.


Assuntos
Adolescente Hospitalizado/psicologia , Criança Hospitalizada/psicologia , Hospitais Pediátricos , Deficiência Intelectual/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto Jovem
18.
Curr Opin Support Palliat Care ; 12(1): 52-57, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29206700

RESUMO

PURPOSE OF REVIEW: This review aims to synthesize recent findings on anticipatory grief in caregivers, referring to its phenomenology, assessment and clinical interventions. RECENT FINDINGS: Recent literature illustrates the wide scope of the current use of the term anticipatory grief, reflecting caregivers' experiences in different end-of-life trajectories. The anticipation of death is the distinctive aspect of anticipatory grief in the predeath grief continuum, encompassing several progressive losses, past and future. Recently developed assessment instruments capture key aspects of this experience, such as separation anxiety, anticipation of death and future absence of the person, denial and relational losses. Recent findings on prevalence of clinically significant predeath symptoms in caregivers range from 12.5 to 38.5%. Beyond personal and relational factors, difficult circumstances of end-of-life care significantly interfere in adjustment to anticipatory grief. Useful therapeutic interventions were identified, such as validation of grief feelings, increased coping and self-care, anticipation of future losses and reframing roles. However, rigorous interventional studies are needed to create guidelines and the manualization of specific therapeutic approaches to caregiver anticipatory grief. SUMMARY: Findings suggest that anticipatory grief dynamics in different end-of-life trajectories should be recognized and adequately assessed. Clinical interventions considered useful to support anticipatory grief caregivers are presented, but further research is needed to verify effectiveness.


Assuntos
Cuidadores/psicologia , Pesar , Assistência Terminal/psicologia , Adaptação Psicológica , Adolescente , Adolescente Hospitalizado/psicologia , Criança Hospitalizada/psicologia , Demência/epidemiologia , Demência/psicologia , Humanos , Neoplasias/epidemiologia , Neoplasias/psicologia
19.
Acad Pediatr ; 18(1): 102-110, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28778828

RESUMO

OBJECTIVE: We examined the self-reported preparedness of hospitalized adolescents and young adults (AYA) for transition from pediatric to adult-oriented health care with regard to: 1) previous health care transition (HCT) preparation, 2) Self-Determination Theory (SDT) constructs of health self-management autonomy and competence, and 3) their perception of medical knowledge, attitudes, and concerns. METHODS: From 2013 to 2015, 139 hospitalized patients aged 15 to 21 years completed a 40-item survey on HCT preparation, attitudes, concerns, and perception of knowledge adapted in part from validated questionnaires of the Department of Health and Human Services, Maternal and Child Health Bureau, and SDT Treatment Self-Regulation Study. RESULTS: Fewer than 40% of all respondents endorsed previous HCT preparation such as providers discussing taking responsibility for their health, transitioning to adult providers, and only 20% had discussed future health insurance needs. Of our AYA population, 84% had 1 or more special health care needs. Older patients, female patients, and those with increased HCT preparation scores had increased autonomous motivation, positive attitudes toward transition, yet also increased transition concerns. Higher autonomous motivation and perceived competence correlated with increased perception of knowledge (P = .002, < .001 respectively) and more positive attitudes toward transition planning (P < .001, .054 respectively). Multivariate regression analysis revealed those with increased HCT preparation and those with increased perceived competence had increased perception of knowledge (ß = .25, P = .005 and ß = .35, P < .001). CONCLUSIONS: Our findings suggest that hospitalized AYA received limited education and preparation regarding key elements of HCT to adult-oriented health care. Moreover, those previously exposed to transition preparation efforts were more likely to have motivation and a sense of competence in HCT skills.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Autoeficácia , Autorrelato , Autogestão , Transição para Assistência do Adulto , Adolescente , Adolescente Hospitalizado , Feminino , Hospitalização , Humanos , Seguro Saúde , Masculino , Motivação , Análise Multivariada , Autonomia Pessoal , Análise de Regressão , Adulto Jovem
20.
Esc. Anna Nery Rev. Enferm ; 22(1): e20170159, 2018.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-891758

RESUMO

Abstract Objective: This study aimed to understand how social networking websites are used by adolescents and their importance during the hospitalization process. Method: A descriptive and qualitative study was supported by the virtual ethnographic method and resorted to the symbolic interactionism as theoretical framework. Eleven hospitalized adolescents were interviewed. Results: Three categories were identified based on the analysis of interviews and posts: Being able to use social networking websites during hospitalization; Using the Facebook® chat to keep connected to friends; Seeking support from friends through social networking websites. Final considerations: Facebook® was the social networking website that adolescents used the most, standing out as an important form of entertainment during hospitalization that facilitates communication and social support. Healthcare professionals should value the use of social networking websites by hospitalized adolescents and encourage access to these tools, providing hospital resources to expand and facilitate this access.


Resumen Objetivo: Este estudio buscó comprender cómo las redes sociales virtuales son utilizadas por adolescentes y su importancia durante el proceso de hospitalización. Método: Estudio cualitativo y descriptivo apoyado en el método de etnografia virtual, utilizando el interacionismo simbólico como referencial teórico. Se realizaron entrevistas con 11 adolescentes hospitalizados. Resultados: A partir del análisis de las entrevistas y de las entradas, identificamos tres categorías: Pudiendo utilizar Facebook® durante la hospitalización; Utilizando el chat de Facebook® para mantenerse conectado con los amigos y Buscando el apoyo de los amigos a través de de las redes sociales virtuales. Consideraciones finales: Facebook® fue la red social más utilizada por los adolescentes, configurándose como una importante forma de entretenimiento durante la hospitalización, facilitando la comunicación y soporte social para los adolescentes. Los profesionales de la salud deben considerar como importante el uso de las redes sociales en línea por los adolescentes hospitalizados, estimulando el acceso y buscando proporcionar recursos para ampliar y facilitar el acceso.


Resumo Objetivo: Este estudo buscou compreender como as redes sociais virtuais são utilizadas por adolescentes e sua importância durante o processo de hospitalização. Método: Estudo qualitativo descritivo apoiado no método de etnografia virtual, utilizando o interacionismo simbólico como referencial teórico. Foram realizadas 11 entrevistas com adolescentes hospitalizados. Resultados: A partir da análise das entrevistas e das postagens, foram identificadas três categorias: Podendo utilizar as redes sociais virtuais durante a hospitalização; Utilizando o chat do Facebook® para manter-se conectado aos amigos; e Buscando apoio dos amigos por meio das redes sociais virtuais. Considerações finais: O Facebook® foi a rede social mais utilizada pelos adolescentes, configurando-se como uma importante forma de entretenimento durante a hospitalização e facilitando a comunicação e o suporte social para os adolescentes. Os profissionais de saúde devem valorizar o uso das redes sociais online pelos adolescentes hospitalizados, estimular o acesso e providenciar recursos que ampliem e facilitam esse acesso.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adolescente Hospitalizado , Cuidados de Enfermagem , Rede Social
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