Adolescents and Young Adults With Spina Bifida Transitioning to Adulthood: A Comprehensive Community-Based Needs Assessment

ObjectiveDeveloping effective interventions to promote successful transition to adulthood for adolescents and young adults (AYA) with spina bifida (SB) requires input from SB community stakeholders, particularly AYA themselves. The goal of this study was to identify and prioritize facilitators and barriers of successful transition to a healthy adult life for AYA with SB.MethodsWe utilized concept mapping, a community-engaged research methodology. We recruited a purposeful sample of SB community stakeholders: AYA with SB, parents/caregivers, pediatric and adult health care providers, and community organizations. Participants generated ideas to open-ended prompts. A subset of participants sorted responses into groups of similar ideas. Multidimensional scaling and hierarchical cluster analysis were applied to generate cluster maps. The concept map was determined by identifying the optimal cluster number that qualitatively represented meaningful and distinct concepts. Concepts were rated by participants for importance and feasibility.ResultsParticipants generated 90 unique ideas that were then sorted. The research team chose a 10-cluster concept map: coordinated and comprehensive medical care, health and wellness, self-management, self-advocacy, skills to maximize independence, inclusivity and relationship supports, physical accessibility of the environment, employment, finances, and community- and school-based resources. Self-management, self-advocacy, and inclusivity and relationship supports were rated as both highly feasible and important.ConclusionsBy using concept mapping to engage diverse stakeholders, including people with intellectual, development, and physical disabilities, this study prioritized less traditional areas like inclusivity and relationship supports to focus improvement efforts relevant to AYA with SB becoming healthy adults.     

Association Among Maltreatment,Bullying and Mental Health,Risk Behavior and Sexual Attraction in Chinese Students

ObjectiveTo identify the association between sexual attraction, childhood maltreatment and bullying victimization, and mental and behavioral health problems among Chinese adolescents.MethodsA cross-sectional study among Chinese high school students by multistage stratified cluster sampling was conducted using a self-reported questionnaire. Participants who were same- or both-sex attracted were identified as sexual minorities, and those who were opposite-sex attracted were identified as heterosexuals. Childhood maltreatment was assessed as physical, emotional, and sexual abuse, and bullying was assessed as traditional and cyberbullying. Psychological distress was assessed as depressive and anxiety symptoms, and self-destructive behavior was assessed as suicidal behavior and nonsuicidal self-injury. Logistic regression and path analysis were conducted to analyze the data.ResultsThere were 1360 sexual minority and 15,020 heterosexual respondents. Sexual minority status was associated with increased risk of maltreatment (adjusted odds ratio [AOR] range: 1.25–2.46) and bullying (AOR range: 1.38–1.77) victimization, and a series of health problems (AOR range: 1.85–3.69). Furthermore, childhood maltreatment could partially explain the association of sexual minority status with psychological distress (indirect effect: β = 0.026 for boys; β = 0.086 for girls) and self-destructive behavior (β = 0.056 for boys; β = 0.125 for girls), and bullying could partially explain the association between sexual minority status and psychological distress (β = 0.040 for boys; β = 0.031 for girls).ConclusionsSexual minority adolescents were more likely than heterosexuals to experience different forms of childhood victimization, which may put them at higher risk for mental and behavioral health problems. Interventions based on both family and school are essential.     

Determinants of Career Satisfaction Among Pediatric Hospitalists: A Qualitative Exploration

ObjectiveTo characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings; to develop a framework to conceptualize factors influencing career satisfaction.MethodsSemistructured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We used closed- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis.ResultsA total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts, which were coded and categorized into 4 domains and associated determinants of career satisfaction: 1) professional responsibilities; 2) hospital medicine program administration; 3) hospital and health care systems; and 4) career development. Although community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these 4 domains. Although the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule, and clinical responsibilities, while tertiary care hospitalists prioritized diversity in nonclinical responsibilities and career development.ConclusionsWe illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and health care quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts.     

Prevalence and Spectrum of Sexual Abuse Among Adolescents in Kerala,South India

Objective

To study the prevalence and spectrum of sexual abuse among adolescents in Kerala, South India.

Methods

A self- report survey was conducted among adolescents in the 15–19 y age group, studying in the plus one and plus two classes in selected schools.

Results

Of the 1614 respondents (688 boys and 926 girls), 36 % of boys and 35 % of girls had experienced sexual abuse at some point during their lifetime. Most instances were sexual advances while using public transport. Feelings of insecurity and isolation at home, of being disliked by parents and of being depressed were significantly more in adolescents who had experienced sexual abuse, compared to those who had not.

Conclusions

Sexual abuse is widely prevalent and both boys and girls are equally susceptible. There is a need to evolve strategies to protect children from sexual abuse and the programmes should address both boys and girls.     

Relationships Between Adolescent Stress,Depressive Symptoms,and Sexual Risk Behavior in Young Adulthood: A Structural Equation Modeling Analysis

IntroductionThis study examined longitudinal associations between stressful life events and depressive symptoms, assessed during two time points of adolescence, and sexual risk behavior, assessed during young adulthood.MethodsStructural equation modeling was conducted with three waves of data from the National Longitudinal Study of Adolescent to Adult Health.ResultsAnalyses revealed bidirectional relationships between stressful life events and depressive symptoms during the two time points of adolescence. Adolescent depressive symptoms indirectly affected young adult sexual risk behavior through adolescent stressful life events. Adolescent stressful life events during late adolescence were directly associated with young adult sexual risk behavior.DiscussionFindings highlight the need to screen for both depression and stressful life events during adolescence, to identify at-risk adolescents and deliver tailored interventions to prevent sexual risk behavior during young adulthood.     

ARSH 1: Reproductive and Sexual Health Problems of Adolescents and Young Adults: A Cross Sectional Community Survey on Knowledge,Attitude and Practice

Objective

To understand the problems faced and the difference in knowledge, attitude and practice of young people across the age group of 10–24 y on reproductive and sexual health issues and to get their suggestions regarding adolescent care services.

Methods

This cross sectional community survey involving three districts in Kerala was conducted among adolescents and young adults of 10–24 y using a population proportion to sample size technique.

Results

The main problems faced by the young people between 10 and 24 y of age were financial, substance abuse in family, poor academic performance, difference of opinion, disease in self/family, mental problems, lack of talent, strict parents, difficulty in mingling, love failure, broken family, loneliness and problems at school/office in the descending order. As the age advances higher percentage of both boys (43.4 %) and girls (61.7 %) discuss reproductive sexual health issues among themselves. There was a statistically significant difference in personal hygiene practices like changing napkins/cloths more than once a day (94.3 %), cleaning genital organs with soap every day (71.7 %), washing after urination (69.2 %), washing from front to back after defecation (62.2 %) and washing hands with soap after defecation (73.2 %) between 10–14, 15–19, and 20–24 y age group with higher percentages in the older groups. In order to make the service more useful, more of the older group participants suggested giving information on adolescent services to parents, adolescents and society as a whole by creating better societal acceptance and keeping confidentiality in service delivery.

Conclusions

This study has shown an overall inadequacy in reproductive health knowledge in all age groups, but increasing knowledge gain and better attitude and practices on reproductive and sexual health as the age increases. The suggestions made by the group regarding need for adolescent reproductive sexual health (ARSH) and counseling services with privacy and confidentiality ensured, is useful for planning ARSH services under National Rural Health Mission.

     

Sexual and Reproductive Health of Young Women With Cystic Fibrosis: A Concept Mapping Study

Objective

Adolescent and young adult (AYA) women with pediatric-onset chronic diseases, such as cystic fibrosis (CF), face disease-specific sexual and reproductive health (SRH) concerns. Using concept mapping (CM), this study aimed to identify the SRH topics and outcomes valued by AYA women with CF and their parents.

Parent Perspectives on Adverse Childhood Experiences & Unmet Social Needs Screening in the Medical Home: A Qualitative Study

ObjectivesTo explore parental perspectives regarding disclosure of child and parental adverse childhood experiences (ACE) and family unmet social needs (USN) and to elicit parental recommendations for screening in the pediatric medical home.MethodsWe conducted a qualitative study using a purposive sample of English- and Spanish-speaking parents in our urban academic community clinic. Between January 2018 and March 2019, each parent underwent one semistructured interview that was audiotaped, transcribed, and independently coded in Atlas.ti by 2 study team members. Data analysis was based in constructivist grounded theory methodology to identify common themes and subthemes.ResultsWe interviewed 25 English-speaking and 15 Spanish-speaking parents who were mostly female, racial/ethnic minorities with ≥1 ACE. English-speaking subjects were more likely to have a high school degree and be single parents. Four themes were identified: 1) Pediatricians should ask about ACE and USN. 2) Disclosure is a longitudinal process, not a discrete event. 3) Barriers to disclosure are significant, involving concrete and emotional risks for the family. 4) Trauma-informed providers and practices support disclosure.ConclusionsFamilies support pediatricians addressing ACE and USN in the medical home despite significant barriers. Even if providers screen using trauma-informed principles, parents may prefer not to disclose ACE initially because they regard disclosure as a stepwise process. These findings contribute to a new conceptual framework for thinking of ACE screening not merely as a way to generate information, but as an interactive, therapeutic relationship-building activity irrespective of whether or when it produces disclosure.     

Water Security Experiences and Water Intake Among Elementary Students at Low-Income Schools: A Cross-Sectional Study

ObjectiveTo examine students’ experiences of water security at school and how experiences relate to intake of water from different sources of water at school.Design/MethodsIn this cross-sectional study, 651 students in grades 3 to 5 in 12 low-income public elementary schools in the San Francisco area completed surveys about their daily intake of water from different sources of water at school, experiences of water security including safety, cleanliness, and taste of water at school, and their demographics. Multivariable linear regressions examined associations between students’ water security experiences at school and reported intake from different sources of water at school.ResultsApproximately half of students were Latino (56.1%) and had overweight/obesity (50.4%). Most (74.5%) had some negative water security experience at school. Students drank from the school fountain or water bottle filling station a mean of 1.2 times/day (standard deviation [SD] = 1.4), sinks 0.2 times/day (SD = 0.7), tap water dispensers 0.2 times/day (SD = 0.6), and bottled water 0.5 times/day (SD = 1.0). In multivariable linear regression, students with more negative experiences of school water security drank less frequently from fountains (-0.5 times/day, P value < .001), but more frequently from tap water dispensers (0.1 times/day, P value = .040) and sinks (0.1 times/day, P value = .043), compared to students with no negative perceptions.ConclusionsOn average, students had negative school water security experiences, which decreased their consumption of water from tap water sources. However, relationships between negative water security experiences and reported water intake appeared to be mitigated by water source. Schools should consider installing more appealing water sources to promote water intake.     

Pathological Study of Postcoronary Arteritis in Adolescents and Young Adults: With Reference to the Relationship Between Sequelae of Kawasaki Disease and Atherosclerosis

To clarify whether the cardiac sequelae of Kawasaki disease (KD), postcoronary arteritis lesions can become a risk factor for atherosclerosis of the coronary arteries, six autopsy cases of patients older than 15 years of age with coronary arterial lesions caused by arteritis in childhood were examined histologically. Twenty-four arteries were inspected: 10 had no evidence of aneurysm formation, 7 arteries manifested simple dilatation of the lumen, and in 7 arteries there were aneurysms with recanalization. In the group in which there were no aneurysms, ``new intimal thickening' was observed in addition to the preexisting intimal thickening which had been caused by arteritis in the acute phase of KD. In the second group with aneurysmal arteries whose lumen remained dilated, thrombotic occlusion occurred in 4 of 6 aneurysms. In addition, advanced atherosclerotic changes (i.e., complicated lesions) were found in a 39-year-old patient. Finally, in the third group of arteries which manifested recanalized lumens after thrombotic occlusion of the aneurysms, new intimal thickening was seen on the internal side and some of them were occluded. The findings in this study suggest that aneurysms present in coronary arteries in individuals with a history of KD constitute a risk factor for atherosclerosis later in life.     

Cardiac Mechanics in Patients With Human Immunodeficiency Virus: A Study of Systolic Myocardial Deformation in Children and Young Adults

Human immunodeficiency virus (HIV) infection causes dysfunction of different organ systems. Myocardial diastolic dysfunction has been reported previously in an adult HIV population. Our aim was to study myocardial strain in children and young adults infected by HIV who have apparently normal ejection fraction. Forty HIV-infected patients (mean age 20.6 ± 1.5 years) with normal ejection fraction and 55 matched normal controls (mean age 17 ± 1.5 years) were studied by two-dimensional echocardiogram. The images were stored then exported to velocity vector imaging software for analysis. Measures considered were left-ventricular peak global systolic strain (LV S) and strain rate (LV SR) as well as right-ventricular peak global systolic strain (RV S) and strain rate (RV SR). Circumferential measures of the left ventricle included the following: LV circumferential peak global systolic strain (LV circ S), strain rate (LV circ SR), radial velocity (LV rad vel), and rotational velocity (LV rot vel) at the level of the mitral valve. Statistical significance was set at p < 0.05. The means of all longitudinal deformation parameters were significantly lower in HIV patients compared with normal controls: LV S (?14.15 vs. ?19.31), LV SR (?0.88 vs. ?1.30), RV S (?19.58 vs. ?25.09), and RV SR (?1.34 vs. ?2.13), respectively (p < 0.05). LV rot vel was lower in patients compared with controls (43.23 vs. 51.71, p = 0.025). LV circ S, LV circ SR, and LV rad vel showed no significant difference between the two groups (p ≥ 0.05). HIV infection affects longitudinal systolic cardiac strain and strain rate in children and young adults. Normal ejection fraction might be attributed to preserved circumferential myocardial deformation. Strain and strain rate may help identify HIV patients at high risk for cardiac dysfunction and allow early detection of silent myocardial depression.