Early intervention with an adolescent twist

The present clinical note outlines the application of the concept of early intervention to early adolescence. This important developmental phase provides numerous opportunities for physicians and other health care professionals to employ disease prevention and health-promoting strategies within the context of their day-to-day clinical interactions with adolescents.     

Demography of adolescent health care delivery and training in Europe

Background  We aimed to determine the status of and factors associated with adolescent health care delivery and training in Europe on behalf of the European Paediatric Association—UNEPSA. Materials and methods  A questionnaire was mailed to the presidents of 48 national paediatric societies in Europe. For statistical analyses, non-parametric tests were used as appropriate. Results  Six of the countries had a paediatric (PSPCA), 14 had a combined and nine had a general practitioner/family doctor system for the primary care of adolescents (GP/FDSA). Paediatricians served children 17 years of age or older in 15 and 17, up to 16 years of age in three and six, and up to 14 years of age in six and six countries in outpatient and inpatient settings, respectively. Fifteen and 18 of the countries had some kind of special inpatient wards and outpatient clinics for adolescents, respectively. Twenty-eight of the countries had some kind of national/governmental screening or/and preventive health programmes for adolescents. In countries with a PSPCA, the gross national income (GNI) per capita was significantly lower than in those with a GP/FDSA, and the mean upper age limit of adolescents was significantly higher than in those with the other systems. In the eastern part of Europe, the mortality rate of 10–14 year olds was significantly higher than that in the western part (p=0.008). Training in adolescent medicine was offered in pre-graduate education in 14 countries in the paediatric curriculum and in the context of paediatric residency and GP/family physician residency programmes in 18 and nine countries, respectively. Adolescent medicine was reported as a recognised subspecialty in 15 countries and as a certified subspecialty of paediatrics in one country. In countries with a PSPCA, paediatric residents were more likely to be educated in adolescent medicine than paediatric residents in countries with a GP/FDSA. Conclusion  The results of the present study show that there is a need for the reconstruction and standardisation of adolescent health care delivery and training in European countries. The European Paediatric Association—UNEPSA could play a key role in the implementation of the proposals suggested in this paper. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Unmet education and training needs in adolescent health of health professionals in a UK children's hospital

Aim: To determine the perceived education and training needs in adolescent health of health professionals. Design: Cross-sectional survey Setting and subjects: Hospital staff in a UK children's hospital. Outcome measures: perceived barriers, confidence, knowledge, skill and prior teaching in key adolescent health subject areas. Results: The hospital survey was completed by 159/1400 professionals representing a completion rate of 11%. Doctors and staff from 'Professions allied to medicine' rated 'lack of training', 'lack of teaching materials' and ' lack of community resources' as the main barriers to providing developmentally appropriate care. Sixty per cent of hospital respondents had received no prior specific training in adolescent health. All but four topics were perceived to be of very high or high importance by the majority of respondents (54-90%). Low scores in perceived knowledge, confidence and/or skill were reported in nine key subject areas (including adolescent mental health and substance use). Differences between doctors and professions allied to medicine were observed in a minority of areas.

Conclusion: Unmet education and training needs of a range of professionals working in a paediatric setting were identified in key areas of adolescent health and they provide useful directions for the development of future multidisciplinary training programmes.     

Promoting child and adolescent mental health in low and middle income countries

Children and adolescents in low and middle income countries (LAMIC) constitute 35–50% of the population. Although the population in many such countries is predominantly rural, rapid urbanisation and social change is under way, with an increase in urban poverty and unemployment, which are risk factors for poor child and adolescent mental health (CAMH). There is a vast gap between CAMH needs (as measured through burden of disease estimates) and the availability of CAMH resources. The role of CAMH promotion and prevention can thus not be overestimated. However, the evidence base for affordable and effective interventions for promotion and prevention in LAMIC is limited. In this review, we briefly review the public health importance of CAM disorders in LAMIC and the specific issues related to risk and protective factors for these disorders. We describe a number of potential strategies for CAMH promotion which focus on building capacity in children and adolescents, in parents and families, in the school and health systems, and in the wider community, including structural interventions. Building capacity in CAMH must also focus on the detection and treatment of disorders for which the evidence base is somewhat stronger, and on wider public health strategies for prevention and promotion. In particular, capacity needs to be built across the health system, with particular foci on low-cost, universally available and accessible resources, and on empowerment of families and children. We also consider the role of formal teaching and training programmes, and the role for specialists in CAMH promotion.     

European Academy of Paediatric consensus statement on successful transition from paediatric to adult care for adolescents with chronic conditions

Around one in ten adolescents suffer from chronic conditions and disabilities, and the transition from paediatric to adult care can be particularly challenging. Unplanned transfers can complicate education, work and health and result in patients being lost to follow‐up, poor treatment adherence and more frequent hospitalisation. The Adolescent Health and Medicine Working Group of the European Academy of Paediatrics has developed a consensus statement for a successful transition. Conclusion: This statement will help paediatricians, adult care specialists, policymakers and other stakeholders to handle chronic care transitions so that they meet the expectations and needs of adolescents and their families.     

Adolescent male health

Although adolescent males have as many health issues and concerns as adolescent females, they are much less likely to be seen in a clinical setting. This is related to both individual factors and the health care system itself, which is not always encouraging and set up to provide comprehensive male health care. Working with adolescent boys involves gaining the knowledge and skills to address concerns such as puberty and sexuality, substance use, violence, risk-taking behaviours and mental health issues. The ability to engage the young male patient is critical, and the professional must be comfortable in initiating conversation about a wide array of topics with the teen boy, who may be reluctant to discuss his concerns. It is important to take every opportunity with adolescent boys to talk about issues beyond the presenting complain, and let them know about confidential care. The physician can educate teens about the importance of regular checkups, and that they are welcome to contact the physician if they are experiencing any concerns about their health or well-being. Parents of preadolescent and adolescent boys should be educated on the value of regular health maintenance visits for their sons beginning in their early teen years.     

Perceptions of community trust and safety - consequences for children's well-being in rural and urban contexts

Aim: To explore the associations between subjective well‐being and perceptions of community trust and safety amongst children in rural and urban areas. Methods: The study used self‐reported data from the 2001/2002 Swedish cross‐national WHO study Health Behaviour in School‐aged Children. The sample consisted of 3852 children aged 11–15 years, living in different residential areas. Bivariate analyses and multivariate logistic regression were performed. Results: The results indicated that a greater proportion of children in urban areas perceived low community trust and safety, compared with children in rural areas. Further, the multivariate analysis revealed that perceived community trust and safety significantly impacts upon children’s subjective well‐being in both rural and urban contexts. Conclusion: Children’s perceptions of trust and safety have different magnitudes in urban and rural areas. The associations of perceptions of community trust and safety for children’s subjective well‐being are relevant in both urban and rural areas. As perceptions of low trust and safety in the community seem to be related to low subjective well‐being, efforts to encourage community trust and safety should be included amongst the key priorities in community health promotion.     

Reproductive health problems and help seeking behavior among adolescents in urban India

Objective To assess their reproductive health problems and help seeking behaviour among urban school going adolescents. Method A sample of 300 urban school going adolescents between 11–14 years were chosen at random and assessed using four tools namely, self administered questionnaire: provision of adolescent friendly services; medical screening and focus group discussions. Results Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. Conclusion Our study shows that to increase help seeking behaviour of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.     

Managing adolescent behavioural and mental health problems in the Emergency Department

Children and young people with behavioural issues frequently present to Emergency Departments. These are complex cases, often with a long preceding history. Caring for them requires a structured approach to ensure safety for the patient and all those involved. The HEADSS assessment is used as a framework. The Emergency Department focuses on treatment of the acute behavioural issues in the least restrictive manner possible. Ongoing behavioural issues are managed with referral to community and specialist resources.     

Tetanus immunization among adolescent girls in Rural Haryana

This survey was undertaken to estimate tetanus immunization coverage of adolescent girls in a selected rural community of Haryana and to ascertain the knowledge of these girls and their mothers about tetanus. The study period was between April 1996–March 1997. A 30-cluster immunization coverage house to house survey was carried out by a female social worker. The total population covered was 30448. Twelve roadside villages were selectively chosen. Eleven year and 17 year old girls (210 in each group) were surveyed for coverage evaluation. For K.A.P. survey 114 grils (aged 17 years) and 98 mothers (of 11 year old girls) were interviewed. Chi square, percentage and 95% confidence interval were used for statistical analysis. Coverage for tetanus immunization was 44.3% among 17 year old girls and 26.7% among 11 year old girls. The coverage was better (35%) among school going girls as compared to non-school going girls (13%). Correct immunization schedule of pregnant women was told by 16 (7.5%) respondents. None of them told the correct immunization schedule for children. Death was told as the main danger from tetanus by 172 (81%) respondents. Most (98%) were aware of the role of clean-stump (umbilical cord) at the time of delivery in the etiology of tetanus neonatorum. Tetanus immunization coverage needs to be improved among adolescents. They also need to be educated on various aspects of tetanus.     

Adolescent Lifestyle Profile-Revised 2: validity and reliability among adolescents in Chile

ObjectiveThe aims of this study were twofold. First, to provide evidence of the validity and reliability of the Adolescent Lifestyle Profile-Revised 2 (ALP-R2) among adolescents in Chile; and second, to examine the relationship between the health-promoting behaviors measured by this scale and several demographic variables.MethodsCross-sectional survey. Students attending grades 9 through 12 from schools representing low-, middle-, and high-income families were included. All schools were in the city of San Felipe, Chile. Students completed the ALP-R2, a fourty-four-item scale aiming to assess health-promoting behaviors. To evaluate validity and reliability, confirmatory factor analysis and omega coefficient calculation were conducted, respectively.ResultsThe sample size was 572 students (82.5% of the eligible population). More males (56.6%) than females (43.4%) participated in the study, and the mean age was 16.4 (SD, 1.3) years. The ALP-R2 had adequate adjustment indicators in the confirmatory factor analysis, which means that the data supports the original theoretical model (seven subscales). The highest internal consistency was obtained for the total scale (Ω = 0.87); and (among the subscales), physical activity (Ω = 0.85) and spiritual health (Ω = 0.78) had the highest reliability.ConclusionsThe ALP-R2 appears to be a valid and reliable instrument to assess health-promoting behaviors among adolescents attending secondary schools.     

Hormonal alterations in adolescent chronic fatigue syndrome

Aim: The chronic fatigue syndrome is associated with alterations in the hypothalamus‐pituitary‐adrenal axis and cardiovascular autonomic nervous activity, suggesting a central dysregulation. This study explored differences among adolescent chronic fatigue syndrome patients and healthy controls regarding antidiuretic hormone, the renin‐angiotensin‐aldosterone‐system, sex hormones and cardiac peptides. Methods: We included a consecutive sample of 67 adolescents aged 12–18 years with chronic fatigue syndrome diagnosed according to a thorough and standardized set of investigations, and a volunteer sample of 55 healthy control subjects of equal gender and age distribution. Hormones were assayed with standard laboratory methods. Results: Among patients, plasma antidiuretic hormone was significantly decreased and serum osmolality and plasma renin activity were significantly increased (p ≤ 0.001). Serum concentration of aldosterone, cortisol, NT‐proBNP and sex hormones were not significantly different in the two groups. Conclusion: Chronic fatigue syndrome in adolescents is associated with alterations in hormonal systems controlling osmolality and blood volume, possibly supporting a theory of central dysregulation.