1
|
Gray SH. Managing menstruation for medically complex paediatric patients. Arch Dis Child 2024:archdischild-2024-326968. [PMID: 38811058 DOI: 10.1136/archdischild-2024-326968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024]
Abstract
Physicians who care for children and adolescents need evidence-based information about how to manage menses for medically complicated patients. The use of many hormonal medications for menstrual management is considered 'off-label' because many of these medications have indications only for contraception. A growing body of evidence supports the use of particular medications or strategies for a wide variety of medical conditions, but this information has been slow to reach all paediatric patients, perhaps in part because of the off-label nature of prescribing. Specialists skilled in hormone management are in short supply and often not immediately available for consultation, and they may also be inexperienced prescribing for medically complex paediatric patients. Misconceptions about the necessity of menstruation or concerns regarding use of contraceptives in young patients may also limit the use of medically indicated off-label hormonal regimens. This review will outline current patient-centred strategies to inform physicians' choices about when and how to intervene medically to improve quality of life for medically complex girls with problematic periods-whether by making periods more predictable, preventing ovulation, reducing pain or eliminating menses altogether.
Collapse
Affiliation(s)
- Susan H Gray
- Pediatrics, University of Virginia School of Medicine, Charlottesville, USA
- Teen and Young Adult Health Center, University of Virginia Health System, Charlottesville, Virginia, USA
| |
Collapse
|
2
|
Santana CAS, Rosenbaum P, van der Kemp J, de Campos AC. Looking beyond Body Structure and Function: ICF Foci and Who Is Being Assessed in Research about Adolescents and Young Adults with Cerebral Palsy-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:670. [PMID: 38928917 PMCID: PMC11203594 DOI: 10.3390/ijerph21060670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study is to summarize the ICF foci, looking beyond body structures and function, and to analyze who has been assessed in research about adolescents and young adults (AYAs) with CP in the phase of transition to adulthood. METHOD Medline, EMBASE, PsycINFO, and CINAHL databases were searched using terms related to cerebral palsy, adolescents/young adults, health development, participation, and independence. Studies including youth with CP (13-30 years old) published in English from 2014 to 2021 were considered. The methods of assessment reported in the included studies were used to identify the ICF foci and who was assessed. RESULTS In this study, 86 studies were reviewed. The main ICF foci are activity and participation (51% of the studies), personal factors (23%), ICF not covered (14%), ICF not defined (9%), with environmental factors being the least focused ICF component (3%). Most studies assessed AYAs directly (49% of studies). CONCLUSIONS Activity- and participation-related constructs are the leading research focus of studies, and more attention is needed concerning environmental factors. AYAs are the main source of information, and the perspectives of other key figures are also being valued. To bridge the gap between child and adult health care, a broader view of health development and approaches to explore AYA developmental issues must be taken.
Collapse
Affiliation(s)
- Camila Araújo Santos Santana
- Physiotherapy Department, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jet van der Kemp
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, 3584 Utrecht, The Netherlands
| | - Ana Carolina de Campos
- Physiotherapy Department, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
| |
Collapse
|
3
|
Schreiber T, Solebo AL. The Experience of Menarche for Young People With Sensory and Motor Impairments: A Systematic Review. J Adolesc Health 2024; 74:223-231. [PMID: 37815768 DOI: 10.1016/j.jadohealth.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 10/11/2023]
Abstract
Young people with disabilities may face barriers to optimal management of menstrual health, including the management of menarche, a unique stage of development. This systematic review examined the barriers to and facilitators of a positive experience of menarche for young people with visual, hearing, or mobility impairments. The MEDLINE, Embase, PsychINFO bibliographic databases, and grey literature were systematically searched in February 2022 to identify relevant research. Thematic synthesis of the extracted study findings was undertaken, using a team-based approach. A total of seven primary qualitative, and 1 mixed method studies were eligible for inclusion. The themes identified through metasynthesis were: timeliness of pre-menarcheal access, with many being unaware of menarche before it occurred, leading to fear and shock at their first period; resonance, with individuals reporting positive impacts of guidance from those with similar disabilities; and frame, the impact of surrounding societal narratives on the experience of menarche. Families, and those involved in the care of children with visual, hearing, and mobility impairments should be made aware of the importance of timely and resonant menarcheal support and guidance for these individuals and of broadcasting positive surrounding narratives of menarche. This should enable a positive experience of menarche for these vulnerable young people, supporting a good trajectory for later-life menstrual health.
Collapse
Affiliation(s)
- Tamar Schreiber
- Population, Policy and Practice Research and Teaching Department, UCL GOS Institute of Child Health, London, United Kingdom
| | - Ameenat Lola Solebo
- Population, Policy and Practice Research and Teaching Department, UCL GOS Institute of Child Health, London, United Kingdom; Department of Opthamology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
| |
Collapse
|
4
|
Streur CS, Kreschmer JM, Ernst SD, Quint EH, Rosen MW, Wittmann D, Kalpakjian CZ. "They had the lunch lady coming up to assist": The experiences of menarche and menstrual management for adolescents with physical disabilities. Disabil Health J 2023; 16:101510. [PMID: 37544804 PMCID: PMC11008706 DOI: 10.1016/j.dhjo.2023.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Menarche is a pivotal time in an adolescent's life but can be experienced differently by those with physical disabilities. Parents typically serve as the primary educators and support for their daughters during this time. Little is known about the parent's perspective of their daughter's experience preparing for menarche and learning to manage menses. OBJECTIVE We sought to understand the parent's perspective of the experience of their daughter with a physical disability around menarche and their preferences for health care provider support. METHODS Individual semi-structured interviews were conducted with 21 parents of a daughter with a physical disability ages 7-26. Interviews were coded by 2 reviewers using Grounded Theory, with disagreements resolved by consensus. RESULTS Six themes emerged regarding the parent's perception of the experiences, including 1) variation in emotional responses to menarche, 2) parent's perception of their daughter's experience with menses and menstrual symptoms, 3) cross-section of disability and menstrual management, 4) menstrual management at school, 5) parental knowledge correlating to daughter's preparation for menarche, and 6) desires for health care provider support. CONCLUSIONS All parents reported that their daughters faced challenges during menarche, ranging from emotional distress to dealing with the inaccessibility of hygiene products. Managing periods at schools was particularly burdensome. Parents who were better educated about what to expect were better able to prepare their daughters, but had difficulties finding informed, supportive providers. Health care providers should provide both anticipatory guidance and holistic, respectful, and equitable options for the management of menstrual symptoms.
Collapse
Affiliation(s)
- Courtney S Streur
- Departments of Urology and Pediatrics, University of Michigan, United States.
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
| | - Susan D Ernst
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | | | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
| |
Collapse
|
5
|
Türker D, Doğan H, Coban O, Goksuluk MB, Özengin N, Ün Yıldırım N. Menstrual health and genital hygiene status in adolescent girls and young women with cerebral palsy. Women Health 2023; 63:243-250. [PMID: 36775296 DOI: 10.1080/03630242.2023.2171175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Menstrual health and genital hygiene behavior in patients with cerebral palsy (CP) is underrecognized, undertreated, and negatively affects quality of life. The aim of this case-control study is to compare menstrual health and genital hygiene behaviors in adolescent girls and young women with CP to a healthy women control group. Participants were invited to study via social media tools between August 2021 and February 2022. The study included 74 adolescent girls and young women with CP and 89 healthy women. Menstrual status with semi-structured questions, menstrual symptoms with "Menstrual Symptom Questionnaire (MSQ)," genital hygiene behavior with "Genital Hygiene Behavior Scale (GHBS)" were evaluated. The control group scored significantly higher on the MSQ sub-dimensions of "negative effects somatic complaints" (r = 0.396; p < .001), "menstrual pain" (r = 0.287; p < .001), "coping methods" (r = 0.291; p < .001), and total score (r = 0.395; p < .001), as well as the GHBS sub-dimensions of "awareness of abnormal findings" (r = 0.270; p = .001) and "menstrual hygiene" (r = 0.495; p < .001) and total score (r = 0.393; p < .001). People with CP had worse genital hygiene behavior, had less menstrual symptoms, and behaved differently about the menstruation symptoms. This study focused on adolescent girls and young women with CP who cannot easily express their own experiences and concerns, emphasized that their needs should be identified by determining their menstrual health and genital hygiene behaviors.Clinical Registration Name, Registration Number, Registration Date: Menstrual Health and Genital Hygiene Status in Cerebral Palsy and NCT04985045, August 2,2021.
Collapse
Affiliation(s)
- Duygu Türker
- Gülhane Faculty of Physiotherapy and Rehabilitation, Health Sciences University, Ankara, Türkiye
| | - Hanife Doğan
- Sarıkaya School of Physiotherapy and Rehabilitation, Bozok University, Yozgat, Türkiye
| | - Ozge Coban
- Gülhane Faculty of Physiotherapy and Rehabilitation, Health Sciences University, Ankara, Türkiye
| | - Merve Basol Goksuluk
- Faculty of Medicine, Basic Medical Sciences, Erciyes University, Kayseri, Türkiye
| | - Nuriye Özengin
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Bolu Abant İzzet Baysal University, Bolu, Türkiye
| | - Necmiye Ün Yıldırım
- Gülhane Faculty of Physiotherapy and Rehabilitation, Health Sciences University, Ankara, Türkiye
| |
Collapse
|
6
|
Giles ML, Juando-Prats C, McPherson AC, Gesink D. “But, You’re in a Wheelchair!”: A Systematic Review Exploring the Sexuality of Youth with Physical Disabilities. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Kaçan H, Bayram Değer V, Sakız H. Outcomes of genital hygiene and anxiety training for mothers of girls with profound intellectual disabilities: A randomized controlled experiment. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:651-664. [PMID: 38983497 PMCID: PMC11229722 DOI: 10.1080/20473869.2022.2129126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/22/2022] [Indexed: 07/11/2024]
Abstract
Female children with profound intellectual disabilities (IDs) may experience symptoms of urinary tract infections (UTIs) and depend on others' care. However, their caregivers may lack general hygiene skills and experience heightened anxiety when their care is expected. This study reports outcome of a training that aims to enhance genital hygiene skills and decrease anxiety levels of mothers of girls diagnosed with profound ID. The study was conducted in a city located in Turkey in 2020. It was designed with a randomized controlled experimental approach based on a pre-test and post-test model with experimental and control groups. The sample consisted of 66 mothers of girls who were diagnosed with profound ID, did not have UTI but were at high risk of developing it. A 6-week program with 24 sessions was implemented. After the training, mothers in the experimental group changed the sanitary pad and the underwear during menstruation and gave their daughters a bath more frequently; had a higher knowledge of recognizing and preventing UTI symptoms and cleaning of the perineum area; and had significantly lower levels of anxiety. A carefully designed simulator-based training can enhance the knowledge and skills of mothers to recognize the UTI symptoms, apply their knowledge to prevent the symptoms and implement genital hygiene practices, which in turn have a positive effect on reducing their level of anxiety.
Collapse
Affiliation(s)
- Havva Kaçan
- Department of Nursing, Faculty of Health Sciences, Kastamonu University, Kastamonu, Turkey
| | - Vasfiye Bayram Değer
- Department of Nursing, Faculty of Health Sciences, Mardin Artuklu University, Mardin, Turkey
| | - Halis Sakız
- Department of Educational Sciences, Faculty of Letters, Mardin Artuklu University, Mardin, Turkey
| |
Collapse
|
8
|
Rashid A. Yonder: Migrant workers, compassionate touch, puberty, and Happify. Br J Gen Pract 2021; 71:371. [PMID: 34326087 PMCID: PMC8312663 DOI: 10.3399/bjgp21x716717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- GP and Clinical Associate Professor, UCL Medical School, UCL, London. @Dr_A_Rashid
| |
Collapse
|
9
|
The effect of functioning on Quality of Life Inventory-Disability measured quality of life is not mediated or moderated by parental psychological distress. Qual Life Res 2021; 30:2875-2885. [PMID: 33939076 DOI: 10.1007/s11136-021-02855-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The measurement of quality of life (QOL) in children with intellectual disability often relies upon proxy report via caregivers. The current study investigated whether caregiver psychological distress mediates or moderates the effects of impairment on their ratings of QOL in children with intellectual disability. METHODS Caregivers of 447 children with an intellectual disability reported their child's day-to-day functioning, their own psychological distress using the Kessler Psychological Distress Scale, and the Quality of Life Inventory-Disability (QI-Disability), a measure of QOL for proxy report of a child's observable behaviours that indicate quality of life. Linear regression was used to assess the effects of the child's functional abilities on their QI-Disability score and causal mediation analysis to estimate the extent to which these effects were mediated by caregivers' psychological distress. RESULTS A minority of caregivers (n = 121, 27.1%) reported no psychological distress. Lower day-to-day functional abilities, such as being fully dependent on others to manage their personal needs were associated with lower total QOL scores. There was no significant mediation effect of caregiver psychological distress on the association between child functioning and total QOL scores. Moderation analyses revealed small and largely nonsignificant interaction coefficients, indicating that caregiver psychological distress did not influence the strength of the relationship between child functioning and total QOL scores. CONCLUSION Caregiver psychological distress did not mediate or moderate the relationship between the level of functional abilities and QOL in children with intellectual disability. QI-Disability measured observable child behaviours which may reduce the influence of caregiver factors on the accurate measure of QOL for children with intellectual disability.
Collapse
|
10
|
Abstract
Current societal and technological changes have added to the ethical issues faced by people with cerebral palsy. These include new representations of disability, and the current International Classification of Functioning, Disability, and Health, changes in legislation and international conventions, as well as applications of possibilities offered by robotics, brain–computer interface devices, muscles and brain stimulation techniques, wearable sensors, artificial intelligence, genetics, and more for diagnostic, therapeutic, or other purposes. These developments have changed the way we approach diagnosis, set goals for intervention, and create new opportunities. This review examines those influences on clinical practice from an ethical perspective and highlights how a principled approach to clinical bioethics can help the clinician to address ethical dilemmas that occur in practice. It also points to implications of those changes on research priorities.
Collapse
Affiliation(s)
- Bernard Dan
- Université libre de Bruxelles, Brussels, Belgium.,Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| |
Collapse
|