What Types of Hospitals Do Adolescents and Young Adults With Complex Chronic Conditions Use?

Background and objectiveHospitalizations for children with complex chronic conditions (CCC) at pediatric hospitals have risen over time. Little is known about what hospital types, pediatric or adult, adolescents, and young adults (AYA) with CCCs use. We assessed the types of hospitals used by AYAs with CCCs.MethodsWe performed a cross-sectional study of 856,120 hospitalizations for AYAs ages 15-to-30 years with ≥1 CCC in the 2017 National Inpatient Sample. We identified AYA with CCC by ICD-10-CM diagnosis codes using the pediatric CCC classification system version 2. Hospital types included pediatric hospitals (n = 70), adult hospitals with pediatric services (n = 277), and adult hospitals without pediatric services (n = 3975). We analyzed age trends by hospital type and CCC count in 1-year intervals and dichotomously (15–20 vs 21–30 years) with the Cochran-Armitage test.ResultsThe largest change in pediatric hospitals used by AYA with CCCs occurred between 15 and 20 years with 39.7% versus 7.7% of discharges respectively (P< 0.001). For older AYA (21 to 30 years), 1.0% of discharges occurred at pediatric hospitals, compared with 65.6% at adult hospitals without pediatric services (P < 0.001). Older AYA at pediatric hospitals had more technology dependence (42.5%) versus younger AYA (27.6%, p < 0.001).ConclusionsMost discharges for AYAs ≥21 years with CCCs were from adult hospitals without pediatric services. Higher prevalence of technology dependence and neuromuscular CCCs, as well as multiple CCCs, for AYA 21-to-30 years discharged from pediatric hospitals may be related to specific care needs only found in pediatric settings and challenges transferring into adult hospital care.     

The Birds, the Bees, and the HPVs: What Drives Mothers’ Intentions to Use the HPV Vaccination as a Chance to Talk About Sex?

Parent-child communication about sex is a way to protect adolescents from engaging in risky behavior. The human papillomavirus vaccine provides mothers with a teachable moment to communicate about sex. This study examines mothers' intentions to talk about sex in conjunction with the vaccination of daughters ages 9 to 15 years, using the Theory of Planned Behavior as a framework. A random sample of mothers was surveyed (N = 217). Findings indicated that mothers' intentions were driven by attitudes, subjective norms, and the age at which they intended to vaccinate. Efforts to encourage vaccination should concentrate on strengthening mothers' attitudes about the value of talking about sex and highlight referent persons who support communication about sex.     

Disclosing Study Information to Children and Adolescents: Is What They Want,What Their Parents Think They Want?

Objective

Despite the importance of child assent, there is little consensus on what information should be disclosed and what information is most important to children for decision-making. This study was designed to compare children's/adolescents' priorities for research information with the information parents believe is most important to their children.

Cancer Incidence and Survival (1997–2006) Among Adolescents and Young Adults in the North of Portugal

Cancer is the first cause of natural death among young subjects. Population-based statistics are important to evaluate the burden of disease and the effectiveness of healthcare provision. We aimed to describe cancer incidence and survival among adolescents (15–19 years) and young adults (20–24 years) in the north of Portugal. Data on the cancers diagnosed between 1997 and 2006 were obtained from the Portuguese North Region Cancer Registry, and incidence rates were computed. Vital status was determined until December 2010. Survival was estimated using the Kaplan–Meier survival function. Trends on cancer incidence were assessed using the Joinpoint regression analysis. A total of 1223 cases were diagnosed: 441 among adolescents and 782 among young adults. Overall incidence rate was 198.3 per million adolescents [95% confidence interval (95% CI): 135.7–260.9] and 306.2 per million young adults (95% CI: 262.3–350.0). The most frequent tumors were Hodgkin lymphoma (adolescents: 21.0%; young adults: 14.8%), thyroid carcinoma (adolescents: 11.5%; young adults: 16.2%), and germ cell tumors (adolescents: 11.1%; young adults: 16.3%). Cancer incidence significantly increased among young adults [annual average percent change: 3.6%, (95% CI: 1.7–5.4)], while appears to vary randomly among adolescents. Overall five-year observed survival was 77.2% (95% CI: 72.9%–80.8%) among adolescents and 81.3% (95% CI: 78.4%–83.9%) among young adults, lower in males. In conclusion, cancer incidence among adolescents and young adults is higher in the north of Portugal than in other European countries, especially of thyroid tumors. Between 1997 and 2006, the incidence increased significantly in young adults.     

Implantable Cardioverter-Defibrillators and the Young Athlete: Can the Two Coexist?

Since the incorporation of implantable cardioverter-defibrillators (ICDs) into the management of life-threatening arrhythmias in the 1980s, tremendous advances in device and lead technology have allowed the implantation of ICD systems in younger and smaller patients. The majority of these young patients with “electrical” cardiac disease and a significant number of those with other indications for ICD placement have near normal to normal cardiac function, which has resulted in a large population of young ICD patients with minimal to no symptoms. This population has pushed the boundaries of published guidelines on activity restrictions for the disease state and the presence of an ICD, creating a dilemma for the patient, the family, and the health care team with regard to which activities should be permitted. Strong evidence suggests that vigorous activity increases the probability of life-threatening arrhythmias in the at-risk population. In addition, repetitive training and high levels of exertion may decrease the durability of the ICD system, leading to inappropriate or ineffective device therapy. However, competitive sports promote regular physical activity, even at the novice level, and regular physical exercise confers numerous short- and long-term benefits. The clinician must always balance the potential risk in sports participation for the patient who has an ICD with the documented adverse effects of chronic physical inactivity. The decision to allow sports participation is multifactorial and therefore cannot be made purely on the basis of consensus statements or the patient’s desire to compete.     

What Aspects are Important to Adolescents to Achieve Full Satisfaction in Life?

This study aims to add new knowledge about what aspects adolescents between 11 and 16 years old consider important to achieve full satisfaction in life (AFSL) and to explore the relationship between these aspects, sociodemographic variables and subjective and psychological well-being indicators. The sample is comprised of 763 secondary school pupils from Girona province (north-eastern Spain) who were subject to five psychometric instruments for measuring subjective well-being, one instrument for measuring psychological well-being and the list of aspects that they consider important to achieve full satisfaction in life (AFSLs: Casas et al. 2013). Being happy, having a good time, experiencing new things and feeling that I make other people happy are the AFSLs that score highest across all age groups. The OLS (Campbell et al. 1976) is the subjective well-being indicator that correlates with the most AFSLs. Appreciating the small things in life is an AFSL that contributes to explaining the well-being measured with all the psychometric instruments used and feeling that you are a fair and honest person contributes to explaining all of them except the OLS.     

Adolescents and sports: risk or benefit?

In order to begin to compensate for a lack of data on the effects of athletic participation in the development of adolescent mental health patterns, as well as to assess general health of the adolescent population, the Juvenile Wellness and Health Inventory (JWHS-76) was administered to 1,769 high school students. Our results indicate that sports participation is associated with self-reported lower total risk scores, mental and physical health benefits, and an increased risk of injury. This suggests a positive role for organized sports participation in youth populations. Prospective studies are needed to assess the impact of different sports, mounting performance pressure, and transition into collegiate levels of participation.     

Pitfalls in the diagnosis of hemophilia severity: What to do?

Measurements of factor VIII coagulation activity (FVIII:C) may vary and result in misclassification of hemophilia A with delay in initiation of prophylactic treatment. We describe two young brothers who were diagnosed as moderate hemophilia patients and therefore not prophylactically treated with factor VIII concentrate despite frequent bleeding events. These findings emphasize the importance of (i) multiple measurements of FVIII:C by certified laboratories, (ii) adjustment of treatment when test results do not correspond to clinical symptoms, (iii) relevance of additional DNA mutation analysis in patients with hemophilia A, and (iv) treatment in centers with expertise.