Self-reported health status and use of medical care by 3,500 adolescents in western Sweden. I

Some 3,500 adolescents answered a questionnaire anonymously. The sample represented 85% of the students between the ages 13 to 16 and 65% of the students between 17 to 18 in the three communities studied. The students all had middle class backgrounds. Self-reported illness differed considerably from data found in epidemiological surveys. The self-reported medical panorama was dominated by concerns about acne, tiredness, headaches, stomach pains, sports injuries and allergic disorders. One quarter to one third of the students reported such problems. Overall, 85% of the students reported that they were "completely healthy", at the same time as they also reported an average of 3.1 medical complaints. Self-initiated appointments with physicians were reported with an average of 5.5 during the last year, which is high. About 40% of the students had one complaint for which they wanted to see a physician. About 15% reported that they had had suicidal thoughts.     

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.     

Medical vocational guidance for adolescents–is it effective?

The outcome of school medical vocational guidance was studied in all 1595 students enrolled in 1987 in grade 9 in the primary schools of Linköping. In grade 9, the school health service had listed 249 students with a chronic disorder. These were sent a questionnaire which was answered by 235 students. Only 5/235 stated that vocational information from physicians and school nurses had been important for their choice of career. No more than 22/235 had chosen a medically ill-suited secondary school study course. This figure is close to the number expected, assuming that all choices of study courses are at random. At follow-up in May 1989, no one said that they had changed study course or work due to their medical disorder. Thus, school medical vocational guidance seems to have little effect on the vocational choices of adolescents with chronic disorders.     

Physical fighting and associated health behaviours among Swedish adolescents

Objective : To investigate the prevalence of physical fighting among Swedish adolescents and to compare the health profile and risk-taking behaviour of the fighters with a non-fighting "diplomatic" group. Methods : Results are based on 4516 self-reports, representing 82% of available students with mean age of 13.5, 15.5 and 17.5 years. Results : Among 13.5-year-olds, 22% ofmalesand5% of females reported three or more fights. Fighting decreased with age. Significantly more fighters reported problem behaviours and fewer had healthy habits than the "diplomats". Significantly more fighters also suffered from psychosomatic disorders and injuries requiring medical services. Twenty percent of the fighting males stated that they would definitely continue to fight. Conclusion : The data indicate that physical fighting is strongly associated with other problem behaviours, which needs to be considered when designing prevention and intervention.     

892名卫校女生儿童期性虐待经历及其对心理健康的影响

目的 了解卫校女生儿童时期性虐待发生情况,探讨性虐待经历对学生心理健康的影响,为卫生、教育及其他相关部门制定预防儿童性虐待对策提供参考依据。方法 用自填式问卷,对一所卫校892名女生就有关儿童时期受性虐待经历进行不记名回顾性调查。结果 在被调查的892名女生中,有25．6％(2128／892)报告16岁以前经历过或非身体接触或身体接触的性虐待(身体接触的性虐待中包括被试图性交和被强行性交)。其中129人经历过身体接触的性虐待,占14．5％。52．6％的儿童首次性虐待经历发生在12岁及以下。与没有儿童期性虐待经历的女生比较,有儿童期性虐待经历的女生抑郁情绪量表得分高;健康状况自我感觉评价得分低;有性交行为比例高;在调查的近12个月里有自杀意念或自杀企图、参与或卷入斗殴、以及在调查近30天里曾吸烟饮酒的发生率均明显偏高。结论 儿童性虐待问题在我国并非少见。儿童期性虐待经历是影响受害者心理健康的一个重要因素。     

Computer administration of a school-based adolescent health survey

Objective : To examine the utility of notebook computers in the collection of data in large scale surveys.
Methodology : A notebook computer administered survey of health in adolescents was conducted in 1992 using a multi-instrument questionnaire. Students in school years 7,9 and 11 in private and government schools in Melbourne and rural Victoria participated.
Results : Parental consent was obtained with an 83% response rate. Each student answered questions directly onto the computer taking an average of 68 min to complete the highly branched confidential but not anonymous questionnaire. Students were presented with on average 33% of the 897 possible questions. Over 90% of students reported enjoying using the computer. Those who reported answering the questions honestly all the time ranged from 68 to 85%, increasing with grade level.
Conclusions : The use of computers in survey research provides many advantages in data collection including exposure only to relevant questions and the opportunity of asking sensitive questions.     

Injuries of school-aged children in Japan: Causes and costs

Injuries of school-aged children were presented from several data sources. About 80000 schools, from nurseries to upper secondary schools, operate in Japan and are attended by 24.3 million students. About 97% of these young people are insured by the insurance system of the School Safety Division of the National Stadium and School Health Center of Japan. Annual injuries and illnesses total 1.08 million, 1039 cases being impedimentary and 191 causing death. The average incidence of injury and illness is 4.6%, a rate that has been increasing every year since 1960. The activity at the time of injury, the impairment incurred, and the part of the body injured differ with the type of school and depend mainly on the developmental stage of the child. Minor injuries occur at the rate of about 47 cases in elementary schools and 14 in lower secondary schools versus one benefit-applied injury at a school safety center. The cost of injuries under the control of schools totaled US$124 million per year in 1990. The average amount of benefits per injured student per month was US$63.     

Reported sexual behaviors and self-esteem among young adolescents

Six hundred seventy-seven adolescents in grades 7 through 9 of a blue-collar, midwestern junior high school responded to a survey of sexual behavior and self-esteem. The focus of this study was on the relationship between sexual experience and self-esteem. Fifty-five percent of the students reported having had at least one coital experience; 7% reported having intercourse about once a week. The proportion of sexually experienced adolescents increased with age; 28% of 12-year-olds, 52.7% of 13-year-olds, 60.1% of 14-year-olds, 73.6% of 15-year-olds, and 90% of 16-year-olds reported having intercourse on at least one occasion. More boys of all ages were sexually active than girls. Six percent of students had had, or were suspicious of having had, a sexually transmitted disease; 7.8% were involved in a pregnancy. The average of the self-esteem scores for girls was significantly lower than the average for boys. There was an interaction effect between gender and coital history for self-esteem. Girls who reported having had intercourse had lower self-esteem scores than those who did not. On the other hand, self-esteem of sexually experienced and inexperienced boys did not differ, nor did self-esteem of virginal boys and girls. Boys and girls with a history of sexually transmitted diseases had lower self-esteem than all others. Pregnancy, on the other hand, did not seem to affect self-esteem of the sexually experienced adolescents. This cross-sectional study does not permit determination of whether the lower average self-esteem among certain girls was antecedent to or a consequence of sexual experience.     

Medical Student Participation in Patient- and Family-Centered Rounding: A National Survey of Pediatric Clerkships

ObjectivePediatrics rotations may be medical students’ only experience with patient- and family-centered rounding (PFCR). It is unclear how students participate in or are prepared for PFCR. We surveyed national pediatrics clerkships to determine the prevalence of PFCR and the proportion providing orientation in order to inform a needs assessment for PFCR orientation.MethodsA 5-item peer-reviewed survey was distributed to the Council on Medical Student Education in Pediatrics (COMSEP) membership as part of a larger survey in 2017. Institutional differences among programs performing PFCR were compared using chi-square and t-tests. Responses to 1 open-ended question were coded and grouped into broad categories using content analysis.ResultsThe full COMSEP survey received answers from 190 participants representing 103 medical schools. Our questions received 174 responses representing 94 schools (98 training sites) and had an 85% (83/98) prevalence of student PFCR participation. Although most (n = 108; 85%) reported that their students received PFCR orientation, half (n = 62; 49%) considered orientation “informal,” and only 2 reported using published curricula. After didactics, the most common orientation materials were handouts (n = 33; 26%), videos (n = 13; 10%), and role play (n = 7; 6%). Orientation was most commonly initiated at the start of clerkship (n = 62; 49%) by clerkship administration (n = 38; 30%), but 20% (n = 26) reported resident-led orientation. Qualitative responses (n = 98) were coded and organized into 4 themes; the greatest perceived challenges for medical students on PFCR were communication and anxiety.ConclusionsAlthough most students participate in and receive orientation to PFCR, there is wide variability in the content, timing, and administration of orientation. A nationally disseminated, evidence-based orientation curriculum may reduce educational variability and better prepare students for PFCR.     

Demographic features and attitudes of program directors of combined internal medicine and pediatrics residencies

Combined residency training in internal medicine and pediatrics has proliferated greatly in the last ten years. This survey of program directors (N = 55) of such residency programs reports their personal and professional demographic characteristics as well as their perceptions about aspects of combined training. The directors were more often affiliated with Internal medicine (33 directors [60%]), 47 (85%) were men, their mean age was 44 years, they had been out of medical school for a mean of 19 years, the mean time served as program director was 2.6 years, and 32 (58%) had completed a fellowship. The programs had existed for an average of 4.2 years, the mean entering class size was 2.8 persons, and the mean number of graduates per program was 4.2. We report directors' perceptions of why students choose combined training, why the programs have proliferated, and how these residents differ from family medicine residents. We comment on curriculum design and the goals of combined internal medicine-pediatrics residency training programs.     

A comparison of clinical pediatric patient encounters in university medical center and community private practice settings.

BACKGROUND: Growing numbers of medical students complete clerkships in community private practice (CPP) settings instead of the more traditional university-based clinics, yet few empirical studies have evaluated how setting type impacts clinical experiences, skill development, and student satisfaction. OBJECTIVE: This study compared the pediatric patient encounters seen by third-year medical students in university medical center (UMC) and CPP settings. METHODS: Third-year medical students were required to keep a log of all patients seen during their 8-week pediatric clerkship. Logbook entries were coded and then analyzed for differences in the number and distribution of the primary diagnostic categories between settings. RESULTS: CPP students reported, on the average, seeing over 3 times more patients than UMC students. The case mix distribution also differed significantly by setting. In general, CPP students reported seeing proportionately more routine illnesses, whereas UMC students reported seeing proportionately more uncommon disorders. Because CPP students saw more patients overall, they averaged more cases in almost all diagnostic categories. CONCLUSION: CPP students received more clinical patient exposure than UMC students, except for patients in a few diagnostic categories.     

Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population

We investigated whether adolescents living in a middle-class suburb believed that their health needs were being met, and the extent to which they were willing to utilize local health care resources for a range of problems. Self-administered, anonymous questionnaires were completed by 649 students in grades 9 through 12. The mean age of respondents was 15.4 years; 52% were female, and 95% white. They had ready access to medical care: 90% used a specific private physician. From a list of 15 health problems, 60% indicated that they had seen a health provider for at least one of them, most often for stomach pains (22%), headaches (18%), and coughing (16%). From an identical list, 48% indicated that there was at least one problem for which they had never seen a health provider but would like to, most often for a weight problem (14%), birth control (10%), and emotional upset (9%). Although 20% regularly used illegal drugs, 24% were sexually active, and 38% thought they had a weight problem, only 1%, 4%, and 10%, respectively, had sought care for these matters. A majority of students would not choose to go to a private physician for care related to sexuality, substance abuse, or emotional upset, and would not be willing to seek care for these problems with their parents' knowledge. Ready access to private primary care did not assure attention to important health needs among these suburban adolescents.     

Child abuse study among Swedish physicians and medical students

Background: The purpose of the present paper was to examine the attitudes and experiences of reporting child abuse and neglect among primary care and hospital‐based physicians and to study the responses of physicians and medical students to case vignettes suggestive of possible physical abuse or neglect. Methods: Physicians at the child health centers in Göteborg primary care (n= 44) and the general pediatricians at the pediatric hospital (n= 21) in Göteborg answered a questionnaire regarding their attitude and experiences reporting child abuse and neglect. The physicians and medical students (n= 34) responded to three case vignettes in which child abuse and neglect could be suspected. Results: A majority of the physicians had reported child abuse and neglect to the social services (80%). No differences were found between primary care and hospital‐based physicians in terms of reporting or attitudes. Two‐thirds of the physicians had suspected child abuse and neglect and decided not to report, and the major reason for not reporting was a lack of confidence in social services organization. Twenty‐one percent had never reported a child for abuse or neglect during their working career. Medical students were more likely to report hypothetical cases than physicians. Conclusion: Many physicians have reported child abuse to social services but also have neglected to do so even when suspecting abuse. It is important that medical students’ willingness to report is continued when starting to work clinically and that all physicians should be continuously educated.     

遗传病患者诊治经济学分析

目的对罕见遗传病患者的诊疗状况进行初步调查,就患者的疾病负担及成本构成进行分析。方法对北京大学第一医院儿科2019年4～12月门诊就诊的372例罕见遗传病患儿及其家庭进行调查,统计资料并分析。结果 372例中包括93种罕见遗传病,其中遗传代谢病226例,来自32个省市自治区,发病年龄从日龄2d到27岁,调查时年龄1月龄至30岁。确诊前,61.0%的患者辗转就医1～26年,经历3～6家医院。患者发病形式多样,58%的患者为急性发病,多以惊厥为首发症状。一些患者为慢性起病,如智力运动落后或倒退。57%的患者发病后及时就医。仅4.3%的患者在初诊时得到正确诊断,从发病到确诊花费<1万元。患者在确诊前因盲目诊治花费了不同的费用,其中花费医疗费用<1万元的占4.3%,40.9%的患者花费的医疗费用为1～9万,23.9%的患者花费的医疗费用为10～19万,22.0%的患者花费的医疗费用为20～49万,8.9%的患者确诊前花费的医疗费用在50万元以上。70.0%的患者在得到确诊前被诊断为脑瘫、智力运动落后、癫痫、肾功能衰竭、新生儿溶血、缺血缺氧性脑病、贫血、孤独症、精神病等多种疾病,并接...     

Cerebral palsy: what do medical students know and believe?

OBJECTIVES: Negative attitudes toward people with disabilities, including cerebral palsy, may be related to misunderstandings or lack of knowledge about the disability. If held by medical practitioners, they can have detrimental implications for the care of people with disabilities. The purposes of this study were to examine the knowledge and attitudes of medical students regarding cerebral palsy and to examine the effects of the videotape 'Understanding Cerebral Palsy' on these two areas. METHODS: The attitudes and knowledge regarding cerebral palsy of 54 medical students in their penultimate year were measured before and after watching a video produced to educate health professionals about cerebral palsy. They were assessed using a self-administered questionnaire constructed specifically for the study, adapted from previously validated questionnaires. RESULTS: These medical students generally had limited knowledge about cerebral palsy and displayed negative attitudes toward people with cerebral palsy. It was also found that males had less positive attitudes than females (P = 0.014) and that students educated mainly in Asia had less positive attitudes than students educated mainly in Australia (P = 0.012). The videotape was shown to be effective in improving the students' knowledge about cerebral palsy. A small but significant improvement in attitudes was also shown (P = 0.014), with the attitudes of some students improving dramatically. However, negative attitudes remained in many. CONCLUSIONS: Based on the findings, structured teaching about cerebral palsy is necessary within the medical curriculum at the University of Melbourne. Greater promotion of positive attitudes toward people with cerebral palsy and other disabilities is required.