The Benefits and Challenges of Involving Adolescents in Medical Education: A Qualitative Study

Objective

To explore the potential benefits and challenges of involving adolescents in the education of medical students and residents from the perspectives of adolescents who are hospitalized with chronic health conditions.

Improving Adolescent Depression Screening in Pediatric Primary Care

ObjectiveDepression among adolescents is a leading public health problem. Although screening for adolescent depression in primary care is strongly recommended, screening rates remain low. Effective quality improvement (QI) initiatives can facilitate change. This study aims to assess the impact of a QI learning collaborative on adolescent depression screening and initial plans of care in primary care.MethodsSeventeen pediatric-serving practices in Vermont participated in a QI learning collaborative aimed at improving practitioner knowledge and office systems around adolescent depression screening. Monthly medical record reviews provided monitoring of adolescent depression screening and initial plans of care over 7 months for QI. Randomly sampled annual medical record review data allowed comparison of screening and initial plans of care after the QI learning collaborative between participating and 21 control practices.ResultsAs practices improved their office systems around adolescent depression screening and initial plans of care, data showed marked improvement in depression screening at all 17 practices, from 34% to 97% over 7 months. Adolescents at participating practices had 3.5 times greater odds (95% confidence interval [CI], 1.14–10.98, P = .03) of being screened for depression and 37.5 times greater odds (95% CI, 7.67–183.48, P < .0005) of being screened with a validated tool than adolescents at control practices, accounting for patient characteristics.ConclusionsThere were significant within practice increases in adolescent depression screening after a QI learning collaborative, as well as in comparison with control practices 1 year later.     

Facebook as a Recruitment Tool for Adolescent Health Research: A Systematic Review

BackgroundResearchers are increasingly using social media to recruit participants to surveys and clinical studies. However, the evidence of the efficacy and validity of adolescent recruitment through Facebook is yet to be established.ObjectiveTo conduct a systematic review of the literature on the use of Facebook to recruit adolescents for health research.Data SourcesNine electronic databases and reference lists were searched for articles published between 2004 and 2013.Study Eligibility CriteriaStudies were included in the review if: 1) participants were aged ≥10 to ≤18 years, 2) studies addressed a physical or mental health issue, 3) Facebook was identified as a recruitment tool, 4) recruitment details using Facebook were outlined in the methods section and considered in the discussion, or information was obtained by contacting the authors, 5) results revealed how many participants were recruited using Facebook, and 6) studies addressed how adolescent consent and/or parental consent was obtained.Study Appraisals and Synthesis MethodsTitles, abstracts, and keywords were scanned and duplicates removed by 2 reviewers. Full text was evaluated for inclusion criteria, and 2 reviewers independently extracted data.ResultsThe search resulted in 587 publications, of which 25 full-text papers were analyzed. Six studies met all the criteria for inclusion in the review. Three recruitment methods using Facebook was identified: 1) paid Facebook advertising, 2) use of the Facebook search tool, and 3) creation and use of a Facebook Page.ConclusionsEligible studies described the use of paid Facebook advertising and Facebook as a search tool as methods to successfully recruit adolescent participants. Online and verbal consent was obtained from participants recruited from Facebook.     

Subtypes of Suicidal and Assaultive Behaviors in Adolescent Psychiatric Inpatients: A Research Note

Among 129 adolescent psychiatric inpatients, four subgroups of suicidal and/or assaultive behaviors were identified. A suicidal-only subgroup with no evidence of assaultive behavior was characterized by depression, drug abuse and environmental stresses. An assaultive-only subgroup with no evidence of suicidal behavior exhibited aggressive symptoms and violence at home. A subgroup with both suicidal and assaultive behaviors experienced accidents and family violence. A fourth subgroup had neither suicidal nor assaultive behavior. This subgroup showed eating disorders, depression, minimal assaultiveness and few peer friendships.     

Qualitative studies of type 1 diabetes in adolescence: a systematic literature review

Spencer J, Cooper H, Milton B. Qualitative studies of type 1 diabetes in adolescence: a systematic literature review.     

Cancer incidence among adolescents in France

BACKGROUND: In France, cancer ranks third as the most significant cause of mortality in young people. However, the incidence, the survival, and the management of adolescent cancers have never been studied. The aim of this study is to investigate incidence rate (IR) of adolescents with cancer from data recorded in French Cancer Registries covering eight administrative areas, representing 10% of the French population, over a 10-year period (from 1988 to 1997). PROCEDURE: Data from the FRANCIM network of French population-based Cancer Registries were used to analyze cancer incidence among adolescents aged from 15 to 19 years, excluding basal cell carcinomas of skin. RESULTS: In total, 699 cases were recorded. Of these, 22.9% were lymphomas, 12.7% germ-cell tumors, 11.9% leukemias, 10.6% central-nervous-system tumors, 10.0% bone neoplasms, 7.6% soft-tissue sarcomas, and 19.5% tumors of adulthood (thyroid carcinomas 4.9%, melanomas 9.0%, and other carcinomas 5.6%). The overall IR was 172.9 per million adolescents (M/F: 1.2) with an annual increase of 3% (P = 0.58). Over the two 5-year periods (1988-1992 and 1993-1997) the IR increases significantly for malignant melanomas (respectively 10.4 and 21.2; P = 0.04). CONCLUSIONS: Our findings are similar to that reported by previous studies performed in European and North-American countries. Future studies need to focus on the etiology explaining the increase in incidence, the management and the impact of the type of care on outcomes.     

Children's Oncology Group's 2013 blueprint for research: Adolescent and young adult oncology

The discipline of Adolescent and Young Adult (AYA) Oncology addresses compelling medical and psychosocial needs of AYA patients across the spectrum of cancer survivorship. To be successful, extraordinary collaboration involving multiple scientific disciplines and specialties is required. While AYA Oncology is international in scope, recent AYA‐focused studies conducted in the Children's Oncology Group (COG) have documented survival disparities, toxicity differences, and biological insights that provide the basis for new COG trials and initiatives for this population. This experience will be useful in leveraging the new United States National Cancer Institute Clinical Trials Network to transform AYA Oncology research. Pediatr Blood Cancer 2013; 60: 1055–1058. © 2012 Wiley Periodicals, Inc.     

Properties of the Mood and Feelings Questionnaire in Adolescent Psychiatric Outpatients: A Research Note

Abstract— This study examined the psychometric properties of the Mood and Feelings Questionnaire (MFQ) in 104 adolescent outpatients unending a psychiatric clinic. The clinic offers a special assessment and treatment service for young people with depressive disorders. In this sample the self-report version of the MFQ had acceptable reliability and was a satisfactory screen for major depressive disorder diagnosed by a standardised interview with the child. It was also a useful measure of clinical remission.     

A Review of Attachment Theory in the Context of Adolescent Parenting

The purpose of this article is to review attachment theory and relate the attachment perspective to adolescent mothers and their children. Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world. With respect to cognitive, social, and behavioral domains, securely attached infants tend to have more favorable long-term outcomes, while insecurely attached infants are more likely to have adverse outcomes. Adolescent parenthood can disrupt normal adolescent development, and this disruption influences development of the emotional and cognitive capacities necessary for maternal behaviors that foster secure attachment. However, it appears that if specialized supports are in place to facilitate the process of developing attachment, infants of adolescent mothers can obtain higher rates of secure attachment than normative samples in this population.     

Impairments of Lower Extremity Muscle Strength and Balance in Childhood Cancer Patients and Survivors: A Systematic Review

This review aims to summarize the evidence for impairments of muscle strength and balance during and after treatment for childhood cancer. Thirty-two articles, identified in scientific databases by means of a structured search for investigations of muscle strength and balance in pediatric cancer patients and survivors, are evaluated. A summary of results is given with respect to matching reporting items to provide a qualitative analysis of the evidence. The majority of the studies reached a level 3 rating according to Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 levels of evidence. Muscle strength and balance seem to be impaired in varying degrees depending on the diagnosis, treatment received, and time elapsed between treatment and evaluation. Drawing specific conclusions from the identified studies is difficult because of heterogeneous study samples and methods of research. Individual targeted exercise therapy programs during treatment and follow-up of childhood cancer could help to prevent and further diminish impairments of muscle strength and balance function among childhood cancer patients and survivors.     

Improving Emergency Preparedness in Pediatric Primary Care Offices: A Simulation-Based Interventional Study

ObjectivesPediatric emergencies pose a challenge to primary care practices due to irregular frequency and complexity. Simulation-based assessment can improve skills and comfort in emergencies. Our aim was improving pediatric office emergency preparedness, as measured by adherence to the existing American Academy of Pediatrics policy statement, and quality of emergency care in a simulated setting, as measured by performance checklists.MethodsThis was a single center study nested in a multicenter, prospective study measuring emergency preparedness and quality of care in 16 pediatric primary care practices and consisted of 3 phases: baseline assessment, intervention, and follow-up assessment. Baseline emergency preparedness was measured by checklist based on AAP guidelines, and quality of care was assessed using in-situ simulation. A report-out was provided along with resources addressing potential areas for improvement after baseline assessment. A repeat preparedness and simulation assessment was performed after a 6 to 10 month intervention period to measure improvement from baseline.ResultsSixteen offices were recruited with 13 completing baseline and follow-up preparedness assessment. Eight of these sites also completed baseline and follow-up simulation assessment. Median baseline preparedness score was 70% and follow-up was 75.9%. Median baseline simulation performance scores were 37.4% and 35.5% for respiratory distress and seizure scenarios, respectively. Follow-up simulation assessment scores were 73% and 76.9% respectively (P = .001).ConclusionsOur collaborative was able to successfully improve the quality of care in a simulated setting in a group of pediatric primary care offices over 6 to 10 months. Future work will focus on expansion and improving emergency preparedness.     

Importance of clinical and epidemiological research in defining the long-term clinical care of pediatric cancer survivors

With the increasing number of long-term survivors of childhood cancer, there continues to be a critical need for development and implementation of evidence-based recommendations for clinical follow-up. In order to establish and maintain health-related follow-up guidelines, it is important to recognize the attributes of research from which the recommendations may be formulated. Issues including study design and clinical research methodology, completeness of long-term follow-up for the applicable study population, approaches for assessment of treatment-related exposures, methods utilized for ascertainment and characterization of outcomes, and recognition of potential modifiers of risk (e.g., demographic or treatment-specific factors) are all important considerations when evaluating the results of available research. For the future, greater attention will not only need to be given to further development and maintenance of recommendations for follow-up, but to the scientific evaluation of the recommendations to determine the subsequent impact on health status and quality of life among pediatric cancer survivors.