Motor outcomes of children born extremely preterm; from early childhood to adolescence

Children and adolescents born extremely preterm (EP; <28 weeks’ gestation) are at greater risk of motor impairment, including cerebral palsy and developmental coordination disorder, than their term born peers. Importantly, motor impairment has implications beyond performing motor skills; it negatively affects outcomes as diverse as school success, emotional wellbeing, physical health, and physical activity (PA) participation. This review will outline what is known about PA participation across childhood and adolescence for children born EP and term, recognising that PA may improve physical, social, and mental health outcomes. Critically, PA participation occurs in the context of children's and adolescents’ daily lives, and is influenced by the family, social and physical environment, as well as by the child's personal factors, such as motor impairment. Further research is needed to better understand PA participation levels and correlates for children and adolescents born preterm, to better inform effective and sustainable interventions.     

Adolescent Mothers' Breastfeeding Social Support Needs

Objective:To define aspects of social support that adolescents need from nurses when initiating breastfeeding in the early postpartum.Data Sources:MEDLINE and CINAHL databases for years 2000 to 2009.Data Extraction:Three searches were done using the following subject terms:adolescent mothers and breastfeeding (12 studies),adolescent mothers and breastfeeding and support (24 studies), andbreastfeeding and adolescent mothers and attitudes (15 studies). The 18 studies that were chosen for this synthesized review illuminated the dimensions of social support identified by House.Data Synthesis:The four types of supportive behavior categories identified by House were described in these studies (informational, instrumental, emotional, and appraisal). Esteem support as defined by Sarafino seemed to be synonymous with appraisal support. Many studies identified the importance of network support as a fifth category of supportive behavior in increased breastfeeding duration among adolescents; network support was included in this synthesis. These five types of social support provide a framework for defining supportive nurse behaviors.Conclusions:Nurses in the early postpartum can promote the long‐term health of adolescents and their children through the social support they offer adolescent mothers as they initiate breastfeeding. Network support appears to be essential to adolescents' breastfeeding experiences and needs to be included with informational, instrumental, emotional, and esteem/appraisal support when investigating support for this population. By integrating the five dimensions of social support into their care, nurses play an essential role in providing adolescents with the positive experiences that are so important to establishing breastfeeding.     

Adolescent girls' life aspirations and reproductive health in Nepal

The study described in this paper takes a participatory and positive approach to improving adolescent reproductive health in a rural and urban community in Nepal. It shows that adolescent girls in these communities have dreams and aspirations for a better future and that adults acknowledge and support these ideals. However, social norms and institutions are restrictive, especially for girls, who are often unable to realise their hopes for continuing education, finding better-paid work or delaying marriage and childbearing, and this directly impacts reproductive outcomes. Insight into the broader context of adolescent girls' lives provides a valuable framework for designing positive programmatic actions which take as their entry point the disjuncture between girls' aspirations and realities. Interventions begun in these communities include youth clubs for safe social interaction and literacy classes; training of peer educators to teach life-skills, including for married adolescents; forums for parents, teachers and health service providers to discuss their own concerns and those of adolescents; and work with the community to design programmes that will contribute to greater financial independence and employment opportunities for adolescents.     

Decision analysis of high-risk patient referral

Decisions to refer obstetric patients are often complicated by social and financial considerations as well as medical risks. To study such decisions, 600 Fellows of the American College of Obstetricians and Gynecologists were studied using a new decision analysis technique. It was found that obstetricians base their referrals predominantly on medical factors, but that other considerations can affect a close decision. Physicians differed on their indications to refer, as well as on the weight placed on some factors. Such differences could not be explained by age, training, or practice characteristics. Studying the referral process is important because successful regionalization depends on appropriate referral.     

Female adolescent sexuality. Promoting healthy sexual development

Health care providers must recognize the specific challenges and rewards of providing services for adolescents. Quality care begins with the establishment of trust, respect, and confidentiality between the health care provider and the adolescent. Data suggest that the normal age for beginning puberty is decreasing, which has important clinical, educational, and social implications. The health care provider should be aware of the broad range of potential sexual behaviors involving adolescents, as well as the teen's acceptance of such behaviors, often dictated by age, gender, culture, and education. When providing gynecologic care to adolescent girls, the physician should not only provide contraception and screen for sexually transmitted diseases but should contribute to the development of the patient's sexual health. Especially when providing care for the younger teen, the health care provider must focus on involving a member of the family or another significant adult to provide needed support and guidance. Anticipatory guidance for parents should focus on assessing their parenting styles and promoting supervision. Although parents should strive to maintain open communication with their adolescents, they may not accurately estimate the sexual activity of and the sexual risk for their teenage children. Parents need to be encouraged to consider the implications of their own sexual behaviors. The provider should attempt to foster a comfortable environment in which youth may seek help and support for appropriate medical care while reserving the right to disclose their sexual identity when ready. Health care professionals cannot exclude heterosexual behavior on the basis that a young woman self-identifies as homosexual. Her reported sexual behaviors may not indicate her sexual orientation. Self-definition of sexual orientation is a dynamic process including factors such as fantasies, desires, and behaviors. Self-definition of sexual identity is affected by individual variations in sex, gender, sexual roles, and sexual orientation. Most adolescents want to discuss sexual-related issues with their health care providers and will welcome direct questions about sexual behaviors and possible risks when posed in a confidential and nonmoralistic manner. Discussion of the physical, emotional, familial, and social changes related to adolescence will encourage healthy sexual development.     

Health‐Related Quality of Life Among Adolescents with Polycystic Ovary Syndrome

ObjectiveTo explore health‐related quality of life (HRQoL) among adolescents with polycystic ovary syndrome (PCOS).DesignQualitative study.SettingTwo out‐patient gynecology clinics in Yorkshire, England.ParticipantsFifteen young women diagnosed with PCOS were recruited.MethodsSemistructured interviews were carried out, transcribed verbatim, and subjected to thematic analysis using NVivo software version 2.0.ResultsA few areas were identified where PCOS had a positive impact upon HRQoL (e.g., improved relationships). However, overall the condition had a negative impact upon HRQoL. Weight problems (in particular the difficulties associated with managing/maintaining weight) and body perceptions appeared to be the most significant contributors to a reduced HRQoL. Menstrual dysfunction, fertility issues, and hirsutism also had adverse affects on emotional well‐being, self‐perception (including poor body image, self‐consciousness, & low self‐esteem), social functioning, and sexual behavior. A number of participants described receiving insufficient information from health care professionals (HCPs) and negative experiences in relation to the diagnosis and management of their condition.ConclusionOverall, PCOS has a negative impact on the HR QoL of adolescent girls with the condition. Emotional and social functioning appeared to be most affected rather than areas of physical functioning. Future research is needed to identify ways to improve communication between adolescents with PCOS and their HCPs, particularly around the diagnosis and potential for infertility. Finally, HCPs need to be more aware of the emotional impact of PCOS upon adolescents’ HRQoL and of the potential for poor sexual health through risk‐taking behaviors that may occur due to the potential loss of fertility.     

Schwangerschaft bei Jugendlichen

Pregnancy at juvenile age is a crucial turning point in the respective person’s life. With the decision to deliver the child, a period of time usually dedicated to education, personal advancement and development of social structures is suddenly filled with tasks the young person can not always live up to. Despite extensive sex education by schools as well as at home and via the media, the rate of pregnancies and pursued abortions among adolescents in Germany is steadily increasing. Further efforts are needed to approach this development. Access to designated advisory boards or family planning services, to birth control and information adequate for sexually active adolescents, has to be facilitated. In order to reduce the rate of pregnancies among minors this access should be granted even at an age, jurisdiction does not yet intend to receive any kind of confidential contraceptive and counseling services. Even though there are discrepant data to be found in literature, there is no difference concerning the course of the pregnancy, complications in gravidity or birth, as well as the child’s outcome between adolescents and older mothers-to-be.     

Contraception for adolescents in low and middle income countries: needs, barriers, and access

Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents.     

Reproductive rights of adolescents: the role of social science research

This article discusses the role of social science research in the promotion of adolescent reproductive rights. A central aim of social science research is to identify social, cultural and biomedical origins of sexual and reproductive behavior and ill health. As a consequence, it is able to provide evidence of people's needs and perspectives on various aspects of sexual and reproductive health, as well as on the extent to which informed choices are made. Findings of such research can establish statistically significant evidence of the levels and patterns of sexual activity and the adverse consequences of limited choice. Thus, making governments reassess their commitment to reproductive rights. In addition, research findings provide accurate evaluations of government legislation initiatives and programs, as well as document the constraints on informed and responsible reproductive choices among adolescents. Furthermore, it points to gaps in existing programs, or their delivery, and directions for change that would enhance adolescents' ability to make informed choices.     

Interdependent Barriers to Providing Adolescents with Long-Acting Reversible Contraception: Qualitative Insights from Providers

Study ObjectiveLong-acting reversible contraceptive (LARC) methods are the most effective form of reversible contraception but are underutilized by adolescents. The purpose of this study was to identify the context-specific barriers to providing adolescents with LARC that are experienced by pediatricians, family medicine physicians, and advanced practice nurses (APNs).Design, Setting, Participants, and InterventionsPediatricians, family medicine providers, and APNs (n = 16) who care for adolescents participated in semistructured qualitative interviews. Interview data were analyzed using a modified grounded theory approach.Main Outcome MeasuresPediatricians, family medicine physicians, and APNs self-reported attitudes and practices regarding LARC provision to adolescents.ResultsProvider confidence in LARC, patient-centered counseling on LARC, and instrumental supports for LARC all work interdependently either in support of or in opposition to provision of LARC to adolescents. Low provider confidence in LARC for adolescents was characterized by confusion about LARC eligibility criteria and perceptions of LARC insertion as traumatic for adolescents. Patient-centered counseling on LARC required providers' ability to elicit patient priorities, highlight the advantages of LARC over other methods, and address patients' concerns about these methods. Instrumental support for LARC included provider training on LARC, access to and financial support for LARC devices, and opportunity to practice LARC insertion and counseling skills.ConclusionAlthough none of the identified essential components of LARC provision to adolescents exist in isolation, instrumental support like provider training on LARC and access to LARC devices have the most fundamental effect on the other components and on providers' attitudes and practices regarding LARC for adolescents.     

Perceptions of risk to HIV infection among adolescents in Uganda: are they related to sexual behaviour?

Uganda has been hailed as a success story in the fight against HIV that has seen a reversal in prevalence from a peak of 15% in 1991 to about 6.5% currently Since 1992, the largest and most consistent declines in HIV have occurred among the 15-19-year-olds. While many studies have examined how key behavior changes (Abstinence, Be faithful and Condom use) have contributed to the decline in HIV prevalence, few have studied the relationship between sexual behaviors and risk perception. Using data from the 2004 National Survey of Adolescents, multivariate logistic regression models were fitted to examine the strength of the association between risky sexual behavior and perceived risk among 12-19-year-old adolescents in Uganda. After controlling for other correlates of sexual behavior such as age, education, residence, region and marital status, the findings indicate highly significant positive association between perceived risk and risky sexual behavior among males but not females. The findings reveal that, regardless of their current sexual behavior, most female adolescents in Uganda feel at great risk of HIV infection. The findings also show that adolescents with broken marriages are much more vulnerable to high risk sexual behaviors than other categories of adolescents. These results further emphasize the need for a holistic approach in addressing the social, economic and contextual factors that continue to put many adolescents at risk of HIV infection.     

Social problems of women patients in a private obstetrics and gynecology clinic.

Patients present or exhibit problems other than physical ones to their physicians and need access to some type of assistance for them. Over a 1 year period, women patients were referred to and seen by the medical social worker employed by a private obstetrics and gynecology clinic. Their social problems were studied by content analysis of patients' records, patients' social services cards, and monthly social services summaries. Results showed that 163 women exhibited 288 social problems consisting of three major types, financial, marital, and emotional. Various relationships were shown between the type of social problem and the primary reason the patient visited the clinic. It was also shown that if a patient has a financial problem, she is more likely to have a greater number of social problems than are other patients.     

Postpartum depression in special populations: a review

This review article aims to define and characterize postpartum depression; to discuss the social, financial, regulatory and legal implications of the disorder; and to elucidate its impact on special groups, namely adolescents, immigrants, fathers, and those of different racial and ethnic groups. A MEDLINE review of the current literature was run on postpartum depression, using the key words postpartum depression, depression, pregnancy, peripartum, or postpartum, from the years 2000 to 2011. Postpartum depressive syndromes place women and their children at risk of suicide and infanticide if not appropriately diagnosed and treated. Screening should occur within 4 to 6 weeks postpartum. Women with a history of depression before or during pregnancy, adolescents, those with low incomes and poor social support, or with a history of substance abuse, are especially at high risk. Treatments include antidepressants and psychotherapy. The unique populations of adolescents, fathers, immigrants, and certain racial and ethnic groups require special consideration in terms of diagnosis, screening modalities, and treatment. Collaboration between obstetrical providers and behavioral health professionals can ensure improved outcomes. It was found that postpartum depression is a challenging diagnosis and may be difficult to treat. A multidisciplinary approach is warranted to prevent life-threatening consequences in mothers and their children. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After participating in this activity, physicians should be better able to diagnose postpartum depression and to analyze the social, financial, regulatory and legal implications of the disorder; and to evaluate its impact on special groups, namely adolescents, immigrants, fathers, and those of different racial and ethnic groups.     

The Mpondombili Project: preventing HIV/AIDS and unintended pregnancy among rural South African school-going adolescents

Unintended pregnancy, HIV and other sexually transmitted infections are major threats to the health of South African youth. Gendered social norms make it difficult for young women to negotiate safer sex, and sexual coercion and violence are prevalent. Sexual activity among adolescents is influenced strongly by conservative social norms, which favour abstinence. In reality, most young people are sexually active by the end of the teen years. Girls' decision to have sex is often a passive one, influenced by partners. The Mpondombili Project is a school-based intervention in rural KwaZulu-Natal that aims to promote delay in the onset of sexual activity and condom use as complementary strategies for both sexually experienced and inexperienced youth. Interactive training was carried out with peer educators, teachers and nurses over a 15-month period, and a manual developed. The intervention was implemented in late 2003 with 670 adolescents in two schools. Issues covered included HIV/STI transmission, risk behaviours, HIV testing, pregnancy and contraception, gender inequality, sexual communication and negotiation, managing abusive situations, fear of AIDS, stigma and discrimination and sexual rights. The diversity of young people's relationships and vulnerability to sexual risk call for the promotion of both risk avoidance (delay in sexual initiation) and risk reduction (condom use) together, regardless of ideology, especially where HIV is well-established, to protect their health.     

Prevalence and predictors of burnout among obstetrics and gynecology residents in Canada

The aim of this study is to evaluate the prevalence of burnout syndrome among obstetrics and gynecology residents, as well as the relationship between several demographic and work-related characteristics and the prevalence of burnout. We surveyed 143 residents in obstetrics and gynecology programs across eight provinces in Canada using an electronic survey questionnaire and the Maslach Burnout Inventory Human services survey. The prevalence of high emotional exhaustion was 12.6 % higher among younger than older residents and 12.4 % higher among female compared to male residents. The prevalence of high depersonalization was13.0 % higher among male versus female residents. The prevalence of high emotional exhaustion among residents who reported sufficient supervision during the night shift was significantly lower than among those who reported insufficient supervision (95 % CI ?49.7, ?8.6). Additionally, we found that adequate access to food during the night shift was associated with a lower prevalence of any burnout (95 % CI ?31.8, ?0.2). Similar associations were observed for high emotional exhaustion and high depersonalization. We also found a 22.1 % (95 % CI ?60.0, 15.7) lower prevalence of emotional exhaustion among residents who work 60 h/week or less. Our results suggest decreased levels of burnout in resident physicians who reported sufficient staff supervision, adequate access to food during the night shift, and fewer working hours. Future studies should be directed to examine the effectiveness of different strategies to improve the residency training in obstetrics and gynecology.     

Attitudes to emotional expression,social support and postnatal adjustment in new parents

The study investigated whether perceived antenatal social support and attitudes to emotional expression are associated with postnatal distress in new parents and whether attitudes to emotional expression are themselves linked with perceptions of social support. Eighty‐six women and 66 men expecting their first baby completed the DUKE‐UNC Functional Social Support Questionnaire (FSSQ) and the Attitudes Towards Emotional Expression (AEE) both antenatally and postnatally. Depressive symptoms and well‐being were measured using the Hospital Anxiety and Depression Scale (HADS) and the Well‐being Questionnaire (WBQ), respectively, in the third trimester and at 6 weeks postnatally. The Edinburgh Postnatal Depression Scale (EPDS) was also used to measure depressive symptoms in the postnatal period. Both mothers and fathers reporting higher perceived social support in pregnancy reported significantly lower levels of distress 6 weeks postnatally. Perceptions of emotional support for fathers and both practical and emotional social support for mothers decreased between pregnancy and the postnatal period. Parents with more positive attitudes towards emotional expression reported significantly higher social support. Attitude towards emotional expression was not associated with distress postnatally.

Perceived social support may be protective for new fathers as well as mothers. Further research regarding the link between the psychological health of new fathers, and the transition of the couple to a family is needed.     

Adolescent Contraceptive Counseling

Contraceptive counseling for adolescents is a mental, social, and physical health imperative that accomplishes one aspect of the difficult task of delivering preventive care in the field of obstetrics. The use of efficient physician-nurse teams for the counseling of adolescent couples provides one model of health care delivery; a male and female team can serve as a role model for open discussion in highly charged emotional areas. Professionals in obstetrics and gynecology must equip themselves with necessary counseling skills and devote creative energy to the planning of suitable health settings in which to provide this care.     

Expressive therapy in pediatric and adolescent gynecology.

Children and adolescents seen by gynecologists may have a broad spectrum of emotional needs that can affect the gynecologic examination as well as the young person's overall well-being. The field of expressive therapy is a relatively new one. The therapist uses a variety of techniques to allow the patient to explore feelings, attitudes, or events in ways that may help the patient to develop new strategies to cope with distress. The application of expressive therapy in pediatric and adolescent gynecology appears to be ever more encompassing.