A collaborative outreach clinic for pregnant youth and adolescent mothers: Description of a pilot clinic and its patients

OBJECTIVE:

To describe the pregnant youth and adolescent parents seen at an adolescent health outreach clinic in an urban community setting during a two-year pilot project.

METHODS:

A retrospective chart review of all adolescents who presented at the monthly half-day clinics from January 2008 through January 2010 (n=36) was performed. Measures extracted from charts included demographic information, reason for referral, social history, mental health history and outcome of assessment.

RESULTS:

All participants were female (mean age 17 years). Forty-two percent were pregnant at initial assessment, while the remainder had one or two children, or a recent pregnancy loss. Sixty-one percent had no primary care physician. The primary reason for referral was mental health concerns, most commonly depression. Almost one-half of patients relied on social assistance and almost one-third were living in shelters. At the time of first visit, 42% of patients were not attending school; the highest level of school completed for most patients was grade 8. The majority had a history of mental health issues and previous drug and/or alcohol use.

CONCLUSIONS:

Adolescents presenting to the clinic had a history of disadvantage in terms of income, educational attainment, living arrangements and mental health background, and are in need of various health services including primary care practitioners. These findings will help to inform future program development for these vulnerable youth, and have implications for practitioners caring for this population.     

Retention of skills in neonatal resuscitation

OBJECTIVES:

To evaluate the impact of a neonatal resuscitation course on the theoretical knowledge and practical skills of birthing room personnel, and to evaluate the performance of skills at different times after the course.

DESIGN:

A program evaluation using a before and after cohort study.

SETTING:

Seven level II perinatal centres in the central-east region of Ontario.

PARTICIPANTS:

Seven hundred thirty-seven individuals (medical staff, nurses and respiratory technologists) who worked in birthing rooms.

INTERVENTION:

During an eight-month period, a course in neonatal resuscitation was presented at the perinatal centres. A cohort of 108 (15%) participants received testing before and after the course; the theoretical knowledge and practical performance of 62 of these participants were retested after six and 12 months.

RESULTS:

A significant improvement in both theoretical knowledge and practical skills was seen immediately after the course. Throughout the study, no difference was observed in the performance of nursing staff compared with that of medical staff, nor among the institutions involved. No significant difference in the decline of either theoretical knowledge or practical skills was seen among those who scored well in the original pre-test compared with those who scored poorly.

CONCLUSIONS:

Neonatal resuscitation should be an integral part of continuing education for all personnel involved in obstetrical care because it improves both tested knowledge and performance. Practical skills appear to decline faster than theoretical knowledge. Inservice instruction is required, at least, every six months.     

Prevalence and risk indicators of smoking among on-reserve First Nations youth

OBJECTIVE:

To determine the current prevalence of smoking among First Nations youth living on reserve within the Saskatoon Tribal Council, and to determine the independent risk indicators associated with smoking among First Nations youth.

METHODS:

Students in grades 5 to 8 attending school within the Saskatoon Tribal Council were asked to complete a youth health survey.

RESULTS:

Of 271 eligible students, 204 completed the consent protocol and the school survey, yielding a response rate of 75.3%; 26.5% of youth were defined as current smokers. Regression analysis indicated that older age, not having a happy home life, suicide ideation and having three or more friends who smoke cigarettes were independent risk indicators of smoking in First Nations youth.

DISCUSSION:

Smoking prevalence among on-reserve First Nations youth is quite high. The identification of four main risk indicators should assist with the design of youth smoking prevention and cessation programs.     

A descriptive study of primary health care practices in Ontario’s youth custody facilities

BACKGROUND:

Adolescents admitted to youth custody facilities are often in need of physical and mental health care.

OBJECTIVES:

To describe primary health care practices in Ontario’s youth custody facilities.

METHOD:

A questionnaire regarding facility characteristics and primary health care practices was distributed to the directors of all youth custody facilities in Ontario.

RESULTS:

Most (87.8%) facilities obtained medical histories after the youth arrived, and 92% used health care professionals to perform that assessment. Intake medical examinations were performed on each youth admitted to custody at 94% of all facilities; however, only 57.2% of facilities reported that these examinations were performed by a doctor within 72 h of admission. Performing suicide assessments on all youth at intake was reported by 77.6% of facilities. Continuous health education was provided by 76% of facilities. Facility type and type of management appear to be related to some areas of health services provision.

CONCLUSIONS:

Youth custody facilities in Ontario are providing primary health care services. Weaknesses are, however, evident, particularly in relation to untimely intake medical examinations, failure to provide continuous health education and failure to conduct suicide assessments on all youth at intake. Future research on barriers to health service provision in Canadian youth custody facilities is recommended.     

Television viewing, computer use and total screen time in Canadian youth

BACKGROUND

Research has linked excessive television viewing and computer use in children and adolescents to a variety of health and social problems. Current recommendations are that screen time in children and adolescents should be limited to no more than 2 h per day.

OBJECTIVE

To determine the percentage of Canadian youth meeting the screen time guideline recommendations.

METHODS

The representative study sample consisted of 6942 Canadian youth in grades 6 to 10 who participated in the 2001/2002 World Health Organization Health Behaviour in School-Aged Children survey.

RESULTS

Only 41% of girls and 34% of boys in grades 6 to 10 watched 2 h or less of television per day. Once the time of leisure computer use was included and total daily screen time was examined, only 18% of girls and 14% of boys met the guidelines. The prevalence of those meeting the screen time guidelines was higher in girls than boys.

CONCLUSION

Fewer than 20% of Canadian youth in grades 6 to 10 met the total screen time guidelines, suggesting that increased public health interventions are needed to reduce the number of leisure time hours that Canadian youth spend watching television and using the computer.     

Clinical review of mania, hostility and suicide-related events in children and adolescents treated with antidepressants

BACKGROUND

Recent controversy surrounding the use of non-tricyclic antidepressants and the emergence of suicide-related events, hostility/behavioural activation and mania in youth with depression warrants an exploration of the results from randomized controlled trials (RCTs) and published case reports for the emergence of these adverse events.

OBJECTIVE

To provide a clinical review of the available evidence from RCTs and case reports regarding the safety of nontricyclic anti-depressants in youth with depression.

METHODS

Seven RCTs of antidepressant use in youth with depression, four case reports of suicide-related adverse events, three case reports of hostility/behavioural activation, and 12 case reports of precipitation of mania were reviewed.

RESULTS

The majority of patients with suicide-related adverse events from both RCTs and published case reports were suicidal before the start of antidepressant treatment. Hostility/behavioural activation generally developed within days to weeks after the start of antidepressant treatment; in the majority of cases, symptoms resolved within four weeks of dosage lowering or discontinuation of the medication alone. Rates for precipitation of mania from RCTs ranged from 0% to 6%. In approximately 60% of published case reports, manic symptoms resolved with the discontinuation or lowering of the dosage of medication alone.

CONCLUSIONS

Several trends were observed in the association between adverse events and the use of nontricyclic antidepressants in youth. When prescribing antidepressants to youth, clinicians should closely monitor patients and fully inform them and their families of the risks and benefits of treatment with antidepressants.     

Risk indicators of suicide ideation among on-reserve First Nations youth

BACKGROUND:

Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve.

OBJECTIVE:

To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth.

METHODS:

Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan).

RESULTS:

Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation.

CONCLUSIONS:

Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.     

Practical aspects of genetic testing in ambulatory paediatrics and child health care

BACKGROUND:

An overview of practical aspects of genetic testing in ambulatory practice in Canada.

OBJECTIVE:

To provide an overview and practical references for child health specialists and paediatricians on genetic services that can be provided to their patients.

METHODS/RESULTS:

A review and summary of areas of genetic testing options available across Canada.

CONCLUSIONS:

Modern Canadian paediatric practice requires office-based practitioners to fully understand and utilize genetics testing in their offices.     

Communication regarding breathing support options for youth with Duchenne muscular dystrophy

BACKGROUND:

Ventilators for home use, manual and mechanically assisted coughing techniques, and the services of in-home respiratory therapists are options for youth with Duchenne muscular dystrophy (DMD). Evidence supports the use of these modalities, but there seems to be few youth who are receiving these therapies. Is there a knowledge transfer issue? Is there a lack of resources? What is the best way to discuss the issues? What do youth and parents want?

OBJECTIVE:

To determine practices, attitudes and beliefs regarding the timing and content of client/family communication related to ventilatory support decisions for individuals with DMD.

METHODS:

A questionnaire was sent to all 19 children’s treatment centres in Ontario. The lead clinician responded on behalf of his or her centre. Another questionnaire was given to 11 families who attended a parent support meeting.

RESULTS:

Respondents from the treatment centres who provide services for youth with DMD indicated that there are resources in terms of personnel and an obligation to provide information about ventilatory support, but provision of information is often late and/or inconsistent. The family respondents wanted more information and they wanted it earlier than they are currently receiving it.

CONCLUSIONS:

Parents and youth dealing with DMD have many resources at their disposal in Ontario. The evidence is clear that there are long-term health benefits to providing ventilatory support as well as instruction in coughing assistance. Due to the classical nature of disease progression in DMD, information should be provided within reasonable timelines.     

Determining the benefits and objectives of a child health residency program for Canadian rural family physicians: An international qualitative research study

OBJECTIVES:

To clarify the need for an advanced child health training program for Canadian rural family physicians, and to determine the key learning objectives to enable graduates to become community leaders in child and youth health care.

DESIGN:

Qualitative educational research study.

Setting:

Canada and Australia.

METHODS:

To gather data, the authors carried out semistructured interviews and focus groups with child care consultants, Canadian rural family physicians, child patients and parents, family medicine residents and Australian rural family physicians. Standards of qualitative methodology were applied to identify themes and subthemes.

RESULTS:

It was determined that a family medicine child health program would provide the following benefits: enhanced care by family physicians, improved access to child care, increased attractiveness of family medicine as a career and reduced ‘specialty burden’.Five key learning objectives for graduates were identified: the ability to provide child-centred care, to care for acutely or critically ill children, to care for children with complex needs, to recognize and act on ‘red flags’, and to provide behavioural and mental health care.The Australian general practitioners confirmed that their training provided most of these benefits, and enabled them to achieve the objectives identified.

CONCLUSION:

The present study showed that multiple stakeholders believed that advanced training in child health for rural family physicians would provide better care for children. The study also identified key learning objectives for the program. The present research led to the establishment of a Family Medicine Child Health Residency Program (www.familymedicineuwo.ca/PostGrad/PGY3/ChildHealth.aspx) at The University of Western Ontario (London, Ontario).     

Sexual knowledge of Canadian adolescents after completion of high school sexual education requirements

BACKGROUND:

Formal sexual education is a mandatory component of the high school curriculum in most Canadian provinces. The present study was a preliminary assessment of sexual knowledge among a sample of Ontario adolescents who had completed their high school sexual education requirements.

METHODS:

A questionnaire, testing understanding of the learning objectives of Ontario’s minimally required high school sexual education course, was distributed in a paediatric emergency department to 200 adolescent patients who had completed the course.

RESULTS:

Respondents demonstrated good understanding of pregnancy physiology and sexually transmitted infections, but poor understanding of concepts related to reproductive physiology, contraception, HIV/AIDS and sexual assault. Most respondents could not identify Canada’s age of sexual consent.

CONCLUSIONS:

Respondents demonstrated concerning gaps in sexual knowledge despite completion of their sexual education requirements. Further studies must determine whether a representative, population-based student sample would exhibit similar findings. Sexual education currently offered in Ontario may require investigation.     

Disclosure of research results to research participants: A pilot study of the needs and attitudes of adolescents and parents

BACKGROUND

Researchers have a moral responsibility to offer to return research results to participants, but the needs and attitudes of parents and adolescents with cancer in paediatric oncology regarding the issue are relatively unknown.

OBJECTIVES

To explore the needs of potential research participants or their guardians with respect to the offer of a return of research results.

METHODS

A questionnaire was used in a focus group and in telephone interviews with eight adolescents and 12 parents of children with cancer. The participants were asked to respond to the questions and to comment on the inclusiveness of the questionnaire.

RESULTS

The majority of participants (18 of 20) wished to receive research results. Two somewhat unexpected findings are described. First, all participants in the present study felt that it was the primary responsibility of the participant to retain contact with the researchers for the purpose of obtaining research results. Second, few participants (n=2) indicated that the Internet would be a satisfactory way of transmitting these results. One-half of the participants wished to have face-to-face communication of results.

CONCLUSIONS

These results provide preliminary guidance for the return of research results to participants and validate the use of the questionnaire in a larger study of this issue.     

Success with lifestyle monotherapy in youth with new-onset type 2 diabetes

BACKGROUND:

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS:

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA_1c) of <9% who achieved/maintained target glycemic control (HbA_1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS:

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA_1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA_1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS:

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA_1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.     

Risk indicators for depressed mood in youth: Limited association with Aboriginal cultural status

INTRODUCTION

There have been too few studies on urban Aboriginal youth to permit inferences about depressed mood in this subgroup. The purpose of the present study was to determine whether Aboriginal cultural status is independently associated with moderate or severe depressed mood in youth after controlling for other covariates, including socioeconomic status.

METHODS

Every student between grades 5 and 8 in the city of Saskatoon, Saskatchewan, was asked to complete a questionnaire in February of 2007. Depressed mood was measured with a 12-question depression scale derivative of the 20-question Center for Epidemiologic Studies Depression Scale.

RESULTS

Four thousand ninety-three youth participated in the school health survey. For Aboriginal youth, the prevalence rate of moderate or severe depressed mood was 21.6% in comparison with 8.9% for Caucasian youth (rate ratio 2.43; 95% CI 1.92 to 3.08). Aboriginal cultural status was not associated with depressed mood after adjustment for other covariates in the final multivariate model (OR 1.132; 95% CI 0.682 to 1.881). Parental educational status and sex were confounders to the association between Aboriginal cultural status and depressed mood.

CONCLUSIONS

The recognition that Aboriginal cultural status is not independently associated with moderate or severe depressed mood in youth after full multivariate adjustment allows policy makers to acknowledge that mental health disparity prevention is possible because the determinants of health (ie, education) are modifiable (in comparison with Aboriginal cultural status).     

The role of economic and cultural status as risk indicators for alcohol and marijuana use among adolescents

INTRODUCTION:

A number of reports suggest that Aboriginal cultural status is a major risk indicator for drug and alcohol use. The primary purpose of the present paper was to determine whether Aboriginal cultural status is independently associated with risk behaviours, such as marijuana use and alcohol abuse, among youth after multivariate adjustment for other factors, such as socioeconomic status.

METHODS:

Every student between grades 5 and 8 in Saskatoon, Saskatchewan, was asked to complete a questionnaire in February 2007. Logistic regression was used to determine the independent risk indicators associated with alcohol abuse and marijuana use.

RESULTS:

Four thousand ninety-three youth participated in the school health survey. At the cross-tabulation level, cultural status and neighbourhood income were both strongly associated with alcohol and marijuana use. After multivariate adjustment, the association between Aboriginal cultural status and alcohol abuse was not statistically significant (crude OR=3.52 to adjusted OR=0.80). For marijuana use, the association was significantly reduced (crude OR=9.91 to adjusted OR=2.79). After controlling for all other variables, results showed that low-income youth were 103% more likely to get drunk at least once and were 163% more likely to have tried marijuana at least once.

CONCLUSION:

To be more successful, future policies directed toward reducing risk behaviours among youth should consider neighbourhood income characteristics.     

The relation between weight-based teasing and psychological adjustment in adolescents

OBJECTIVE:

To determine the prevalence of weight-based teasing, and evaluate its association with depression, anxiety and unhealthy eating behaviour in a large sample of adolescents in the Ottawa (Ontario) area.

METHODS:

A total of 1491 adolescents from public and private middle schools and high schools in rural and urban areas of Ottawa responded confidentially to surveys.

RESULTS:

More girls than boys reported that they experienced weight-based teasing (33% versus 18%). The prevalence of weight-based teasing by peers was significantly higher among overweight and obese youth than among normal weight youth (45% versus 22%). Teasing about body weight was consistently associated with anxiety, psychological distress and disordered eating, and these associations held for both boys and girls, and were independent of weight status.

CONCLUSIONS:

Weight-based teasing is a common experience among Ottawa-area adolescents, especially among overweight girls, and was found to be associated with psychological morbidity. Effective interventions are needed to help victims cope with and prevent further weight-based teasing and its harmful psychological sequelae.     

Paediatricians’ awareness of,agreement with and use of the new Canadian Physical Activity and Sedentary Behaviour Guidelines for children and youth zero to 17 years of age

OBJECTIVE:

To examine the awareness of, agreement with and use of the new Canadian Physical Activity and Sedentary Behaviour Guidelines for children and youth zero to 17 years of age in a sample of Canadian paediatricians.

METHODS:

The findings are based on responses from 331 paediatricians across Canada who completed an online survey in February 2013. Frequencies were calculated for each question.

RESULTS:

Few paediatricians reported being very familiar with the physical activity (6% for the early years, and 9% for children and youth) or sedentary behaviour guidelines (5% for the early years, children and youth). When made aware of the guidelines, a large percentage strongly agreed or agreed with the physical activity (99% for the early years, and 96% for children and youth) and sedentary behaviour recommendations (96% for the early years, and 94% for children and youth). Of paediatricians who performed well-child visits, 16% and 27% reported almost always making physical activity and sedentary behaviour recommendations, respectively, to parents or caregivers of children in the early years, compared with 37% for both behaviours among children and youth. Thirty-nine per cent (for the early years) and 46% (for children and youth) of paediatricians reported it would be highly feasible to briefly explain the guidelines at a well-child visit. The most common barriers reported for recommending the guidelines were insufficient motivation or support from parents, caregivers or youth, and lack of time.

CONCLUSION:

To increase the use of these new evidence-informed guidelines, strategies are needed to increase paediatricians’ awareness and reduce perceived barriers.     

Computer/gaming station use in youth: Correlations among use,addiction and functional impairment

OBJECTIVE:

Computer/gaming station use is ubiquitous in the lives of youth today. Overuse is a concern, but it remains unclear whether problems arise from addictive patterns of use or simply excessive time spent on use. The goal of the present study was to evaluate computer/gaming station use in youth and to examine the relationship between amounts of use, addictive features of use and functional impairment.

METHOD:

A total of 110 subjects (11 to 17 years of age) from local schools participated. Time spent on television, video gaming and non-gaming recreational computer activities was measured. Addictive features of computer/gaming station use were ascertained, along with emotional/behavioural functioning. Multiple linear regressions were used to understand how youth functioning varied with time of use and addictive features of use.

RESULTS:

Mean (± SD) total screen time was 4.5±2.4 h/day. Addictive features of use were consistently correlated with functional impairment across multiple measures and informants, whereas time of use, after controlling for addiction, was not.

CONCLUSIONS:

Youth are spending many hours each day in front of screens. In the absence of addictive features of computer/gaming station use, time spent is not correlated with problems; however, youth with addictive features of use show evidence of poor emotional/ behavioural functioning.     

Polymerase chain reaction detection of Kingella kingae in children with culture-negative septic arthritis in eastern Ontario

BACKGROUND:

The bacterium Kingella kingae may be an under-recognized cause of septic arthritis in Canadian children because it is difficult to grow in culture and best detected using molecular methods.

OBJECTIVES:

To determine whether K kingae is present in culture-negative joint fluid specimens from children in eastern Ontario using polymerase chain reaction (PCR) detection methods.

METHODS:

K kingae PCR testing was performed using residual bacterial culture-negative joint fluid collected from 2010 to 2013 at a children’s hospital in Ottawa, Ontario. The clinical features of children with infections caused by K kingae were compared with those of children with infections caused by the ‘typical’ septic arthritis bacteria, Staphylococcus aureus and Streptococcus pyogenes.

RESULTS:

A total of 50 joint fluid specimens were submitted over the study period. Ten were culture-positive, eight for S aureus and two for S pyogenes. Residual joint fluid was available for 27 of the 40 culture-negative specimens and K kingae was detected using PCR in seven (25.93%) of these samples. Children with K kingae were significantly younger (median age 1.7 versus 11.3 years; P=0.01) and had lower C-reactive protein levels (median 23.8 mg/L versus 117.6. mg/L; P=0.01) than those infected with other bacteria.

CONCLUSIONS:

K kingae was frequently detected using PCR in culture-negative joint fluid specimens from children in eastern Ontario. K kingae PCR testing of culture-negative joint samples in children appears to be warranted.     

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes

OBJECTIVE:

To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach.

DESIGN:

Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes.

SETTING:

Paediatric residency program at BC Children’s Hospital, Vancouver, British Columbia.

INTERVENTIONS:

The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale.

RESULTS:

A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration.

CONCLUSIONS:

A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes.