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Turetsky R, Galagali PM, Churchill RD, Jansen DDEMC, Sawyer SM, Klein JD. Answering the Call: International Policy Statement Provides the Framework for Adolescent Health Care Professional Education Globally. J Adolesc Health 2024; 74:400-401. [PMID: 38206226 DOI: 10.1016/j.jadohealth.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Risa Turetsky
- International Association for Adolescent Health, Montreal, Canada.
| | - Preeti M Galagali
- International Association for Adolescent Health, Montreal, Canada; Bengaluru Adolescent Care and Counseling Centre, Bengalaru, India
| | - Richard D Churchill
- International Association for Adolescent Health, Montreal, Canada; Nottingham City General Practice Alliance, Nottingham, United Kingdom
| | - Danielle D E M C Jansen
- International Association for Adolescent Health, Montreal, Canada; Department of Sociology, University of Groningen, Groningen, Netherlands; Department of Primary and Long-Term Care, University Medical Center Groningen, Groningen, Netherlands
| | - Susan M Sawyer
- International Association for Adolescent Health, Montreal, Canada; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Jonathan D Klein
- International Association for Adolescent Health, Montreal, Canada; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Fields EL, Louis-Jacques J, Kas-Osoka O, Holland-Hall C, Richardson LP, Ott M, Leslie LK, Pitts SAB. Child Health Needs and the Adolescent Medicine Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678D. [PMID: 38300009 DOI: 10.1542/peds.2023-063678d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Adolescent medicine (AM) subspecialists provide primary, subspecialty, and consultative care to adolescents and young adults (AYAs). Given insufficient numbers of AM subspecialists to care for all AYAs, the workforce supports AYAs health care capacity through education, research, advocacy, and the development of policies and programs sensitive to their unique needs. A modeling project funded by the American Board of Pediatrics Foundation was developed to forecast the pediatric subspecialty workforce in the United States from 2020 to 2040 on the basis of current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios, and reports results in headcount and headcount adjusted for percentage of time spent in clinical care, termed "clinical workforce equivalent." For the AM subspecialty, several scenarios were considered that modified the number of fellows and/or clinical time. The baseline model predicted low growth nationally (27% and 13% increase in total AM subspecialists and AM subspecialists per 100 000 children, respectively) and declines in AM workforce relative to population growth in census divisions with existing geographic workforce disparities. In the alternative scenarios, fellow number and clinical time changes did not significantly change predictions relative to the baseline model, but a 12.5% decrease in fellows predicted a 40% reduction in the workforce from baseline with a widening of geographic workforce disparities. On the basis of the expansive clinical and nonclinical roles of AM subspecialists and these forecasted workforce challenges, significant educational, practice, and policy changes will be necessary to bolster the supply of well-trained clinicians addressing the dynamic health care needs of AYAs.
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Affiliation(s)
| | | | - Oriaku Kas-Osoka
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cynthia Holland-Hall
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura P Richardson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Mary Ott
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Sarah A B Pitts
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Tellier PP, Ataman R, Zaccagnini M, Gore G, Rodriguez C. Adolescent medicine training in postgraduate family medicine education: a scoping review. Int J Adolesc Med Health 2023; 35:119-129. [PMID: 36584348 DOI: 10.1515/ijamh-2022-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Adolescents and young adults require age-appropriate healthcare services delivered by clinicians with expertise in adolescent medicine. However, resident family physicians report a low perceived self-efficacy and under-preparedness to deliver adolescent medical care. We conducted a scoping review to map the breadth and depth of the current evidence about adolescent medicine training for family medicine residents. CONTENT We followed Arksey and O'Malley's framework and searched seven electronic databases and key organizations' webpages from inception to September 2020. Informed by the CanMEDS-FM, we analyzed the extracted data concerning basic document characteristics, competencies and medical topics using numerical and qualitative content analysis. SUMMARY We included 41 peer-reviewed articles and six adolescent health competency frameworks (n=47). Most competencies taught in family medicine programs were organized under the roles of family medicine expert (75%), communicator (11.8%), and professional roles (7.9%). Health advocate and leader were rarely included (1.3%), and never scholar. OUTLOOK The omission of multiple competency roles in family medicine resident education on adolescents is insufficient for family physicians to deliver optimal care to adolescents. The combined efforts of family medicine stakeholders to address adolescent medicine competency gaps may positively impact the perceived competence reported by family medicine residents.
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Affiliation(s)
| | - Rebecca Ataman
- The School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Laval, QC, Canada
| | - Marco Zaccagnini
- The School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Laval, QC, Canada
| | - Geneviève Gore
- McGill Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montréal, QC, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, Montréal, QC, Canada.,The Institute of Health Sciences Education, McGill University, Montréal, QC, Canada
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Prentice-Hoogervorst L, Mayers PM. Adolescent paediatric transplant patients' experiences of transition to adult services. Health SA 2022; 27:1937. [PMID: 36337443 PMCID: PMC9634670 DOI: 10.4102/hsag.v27i0.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transition of adolescents from paediatric to adult health services is an important aspect of caring for young people with chronic diseases. Successful transition of adolescents living with a transplant is critical for long-term survival into adulthood. This qualitative study explored the lived experience of adolescents in a South African setting following their planned and supported transition process. Aim To explore the lived experience of transition for adolescents who had received a renal or liver transplant as a child, from paediatric to adult transplant services in the public health sector. Setting Cape Town, South Africa. Method Six purposively sampled adolescents, who had participated in a planned transition from a tertiary level children's hospital to the affiliated adult hospital, were interviewed in the setting and language of their choice. The transcribed interviews were analysed using an interpretative phenomenological analysis (IPA) approach. Results Five themes emerged: living with uncertainty in a changing world; being known, not knowing, and knowing; ambivalent relationships; the journey of loss; and being heard. Pre-transition planning, support groups, and consistency of clinicians within an accepting environment facilitated the adolescents' individuation and acceptance of self-care responsibility. Conclusion Carefully planned, collaborative preparation and implementation of a facilitated psycho-supportive intervention for transition can facilitate adolescent cooperation and adherence, minimise the risk of psychological and medical sequelae, and support the adolescent in adapting to living with a transplant as an adult. Contribution This study offers insight into the importance of planned and supported transitional care of adolescents living with an organ transplant.
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Affiliation(s)
- Lesley Prentice-Hoogervorst
- Division of Nursing and Midwifery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pat M Mayers
- Division of Nursing and Midwifery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Roy-Lavallée J, Findlay SM, Chen A, Katzman DK. Adolescent medicine subspecialty workforce: Insights from Canada. Paediatr Child Health 2022; 27:278-284. [DOI: 10.1093/pch/pxac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/18/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Adolescent Medicine (AM) in Canada has undergone significant growth since being accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) in May 2007. A deeper understanding of the workforce is needed in order to identify current gaps, to improve clinical care and scholarly endeavors, and to inform future developments.
Methods
This is the first AM workforce survey administered in Canada and included 39 multiple-choice and 3 open-ended questions. Descriptive statistics were calculated, and thematic analysis was used for open-ended questions.
Results
We identified 62 AM specialists from across Canada. The overall response was 97% (60/62). Most AM specialists were women (39/53, 74%), Caucasian (38/53, 72%), between 30 and 39 years old (22/53, 42%), and completed their subspecialty training in either Toronto (24/48, 50%) or Montreal (12/48, 25%). Nearly half of participants worked in either the Toronto, Ontario (13/49, 27%) or Montreal, Quebec (10/49, 20%). Nearly all participants (46/49, 94%) practiced in large urban population centres and were based in academic health science centres. The primary clinical areas of focus included eating disorders (25/51, 49%) and mental health (9/51, 18%). Almost all participants were satisfied with their career choice (41/50, 82%). Two-thirds of the participants (31/48, 65%) believed that there was an insufficient number of AM specialists in Canada.
Conclusions
Highlighting current characteristics of the AM subspecialty will help government and academic policymakers in understanding the workforce available to care for Canadian adolescents and the need to develop training programs and policies to address gaps and shortages.
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Affiliation(s)
| | - Sheri M Findlay
- Department of Pediatrics, McMaster Children’s Hospital , Ottawa, Ontario , Canada
| | - Allison Chen
- University of Toronto Faculty of Medicine , Toronto, Ontario , Canada
| | - Debra K Katzman
- Department of Pediatrics, The Hospital for Sick Children , Toronto, Ontario , Canada
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Cristóvão Ferreira A, Videira da Silva A, Freira S, Fonseca H. Adolescent medicine during specialized paediatric training: the past, the present and the future. Int J Adolesc Med Health 2021; 33:83-88. [PMID: 33855842 DOI: 10.1515/ijamh-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Paediatricians increasingly need to take care of adolescents, a life stage with specific needs, however many of them admit a limitation in their medical education regarding Adolescent Medicine. The objective of this paperwork is to evaluate the formative model adopted in the Department of Paediatrics, Hospital de Santa Maria, and assess the impact of the training in Adolescent Medicine. METHODS We surveyed the current Paediatric Residents and those who graduated as Paediatricians from the Department in the past five years, in order to get feedback on the one-month compulsory training at the Adolescent Medicine Division during their Residency. RESULTS Both groups considered it as a very interesting/useful training. Paediatricians considered that the training had an insufficient duration, with statistical difference comparing to the current Residents' opinion. Conversely, Residents considered more often that the acquired competencies would be useful in their future clinical practice, when compared to Paediatricians. CONCLUSIONS In order to potentiate learning and training during such a short period of time, a few changes were identified as beneficial to be implemented.
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Affiliation(s)
| | | | - Sílvia Freira
- Department of Paediatrics, Adolescent Medicine Clinic, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Helena Fonseca
- Department of Paediatrics, Adolescent Medicine Clinic, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- University of Lisbon Medical School, Lisbon, Portugal
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Adolescent Neurodevelopment and Vulnerability to Psychosis. Biol Psychiatry 2021; 89:184-193. [PMID: 32896384 PMCID: PMC9397132 DOI: 10.1016/j.biopsych.2020.06.028] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022]
Abstract
Adolescence is characterized by significant changes in several domains, including brain structure and function, puberty, and social and environmental factors. Some of these changes serve to increase the likelihood of psychosis onset during this period, while others may buffer this risk. This review characterizes our current knowledge regarding the unique aspects of adolescence that may serve as risk factors for schizophrenia spectrum disorders. In addition, we provide potential future directions for research into adolescent-specific developmental mechanisms that impart vulnerability to psychosis and the possibility of interventions that capitalize on adolescents' unique characteristics. Specifically, we explore the ways in which gray and white matter develop throughout adolescence in typically developing youth as well as in those with psychosis spectrum disorders. We also discuss current views on the function that social support and demands, as well as role expectations, play in risk for psychosis. We further highlight the importance of considering biological factors such as puberty and hormonal changes as areas of unique vulnerability for adolescents. Finally, we discuss cannabis use as a factor that may have a unique impact during adolescent neurodevelopment, and subsequently potentially impact psychosis onset. Throughout, we include discussion of resilience factors that may provide unique opportunities for intervention during this dynamic life stage.
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Affiliation(s)
- Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Yearwood E, Raphel S, Malmo L, Galehouse P. Analysis of child and adolescent psychiatric-mental health APRN education: Implications for the nursing workforce. Arch Psychiatr Nurs 2020; 34:345-350. [PMID: 33032756 DOI: 10.1016/j.apnu.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Edilma Yearwood
- Georgetown University School of Nursing & Health Studies, Washington, DC, USA.
| | | | - Lisa Malmo
- Mayo Clinic Health Systems, LaCrosse, WI, USA
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Brantly M, Campos M, Davis AM, D'Armiento J, Goodman K, Hanna K, O'Day M, Queenan J, Sandhaus R, Stoller J, Strange C, Teckman J, Wanner A. Detection of alpha-1 antitrypsin deficiency: the past, present and future. Orphanet J Rare Dis 2020; 15:96. [PMID: 32306990 PMCID: PMC7168939 DOI: 10.1186/s13023-020-01352-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022] Open
Abstract
Background Most patients with alpha-1 antitrypsin deficiency remain undiagnosed and therefore do not benefit from current therapies or become eligible for research studies of new treatments under development. Improving the detection rate for AATD is therefore a high priority for the Alpha-1 Foundation. A workshop was held on June 23, 2019 in Orlando, Florida during which stakeholders from the research, pharmaceutical, and patient communities focused on the topic of alpha-1 antitrypsin deficiency detection. Results A variety of detection strategies have been explored in the past and new approaches are emerging as technology advances. Targeted detection includes patients with chronic obstructive pulmonary disease, unexplained chronic liver disease, and family members of affected individuals. Newborn screening, electronic medical record data mining, and direct-to-consumer testing remain options for future detection strategies. Conclusion These meeting proceedings can serve as a basis for innovative approaches to the detection of alpha-1 antitrypsin deficiency.
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Affiliation(s)
- Mark Brantly
- University of Florida College of Medicine, Gainesville, USA
| | | | | | | | | | - Kathi Hanna
- Science and Health Writer / Editor, Seattle, USA
| | | | | | | | | | | | | | - Adam Wanner
- University of Miami School of Medicine, Miami, USA.
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Miller KK. Educational Curricula and Programs in Adolescent Medicine for Health Workers in Low- and Middle-Income Countries: A Scoping Review. J Grad Med Educ 2019; 11:64-72. [PMID: 31428260 PMCID: PMC6697283 DOI: 10.4300/jgme-d-19-00052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adolescent medicine (AM) has been increasingly recognized as critically important to the health of individuals during their transition to adulthood. On a global scale, AM is often underprioritized and underfunded. In low- and middle-income countries (LMICs), education and AM training is developing, and AM physicians often are from general medicine backgrounds. OBJECTIVE The objective of our scoping review was to identify existing training curricula and educational tools designed to teach AM skills to health care workers in LMICs. METHODS We followed PRISMA guidelines for scoping reviews for article identification and inclusion. Online databases, including MEDLINE, Embase, CINAHL, and Scopus, were used to identify papers. We included studies that took place in a LMIC, were available in English, and described any of the following: published educational curricula in AM, education-based intervention for HCWs that focused on AM, or a training opportunity in AM located in a LMIC. RESULTS Our review includes 14 publications: 5 published curricula and 9 articles describing educational interventions or training opportunities in AM in LMICs. Curricula were relatively consistent in the topics included, although they varied in implementation and teaching strategies. The scholarly articles described educational materials and identified a number of innovative strategies for training programs. CONCLUSIONS Our review found existing high-quality AM curricula designed for LMICs. However, there is limited published data on their implementation and utilization. There is a continued need for funding and implementation of education in AM in resource-constrained settings.
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Jirakittidul P, Somyaprasert C, Angsuwathana S. Prevalence of Documented Excessive Weight Gain Among Adolescent Girls and Young Women Using Depot Medroxyprogesterone Acetate. J Clin Med Res 2019; 11:326-331. [PMID: 31019626 PMCID: PMC6469894 DOI: 10.14740/jocmr3792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 02/05/2023] Open
Abstract
Background Depot medroxyprogesterone acetate (DMPA) is an accessible contraception with high efficacy among adolescents. However, concern of weight gain can impede DMPA use. The objective of this study was to determine prevalence of excessive weight gain associated with DMPA injection in young women and its predicting factor. Methods This retrospective chart review included young women aged 10 - 24 years who had used DMPA and attended at Family Planning and Reproductive Medicine Unit, Siriraj Hospital for at least 6-month period during January 2010 to June 2016. Baseline clinical data, weight at beginning of contraception, and weight at 6 and 12 months thereafter were reviewed. Excessive weight was defined as weight gain of > 5% of their baseline weight at 6 months. Various baseline variables were compared between groups with and without excessive weight gain. Results Among 231 DMPA users in this study, there were 28 women (12.1%, 95% confidence interval (CI): 7.8 - 16.3) who had an excessive weight gain at 6 months. Age, baseline body mass index, or race did not affect the likelihood of excessive weight gain. The excessive weight gain group had significant higher proportion of nulliparity, unmarried status and DMPA-ever used history compared to another one. Six of 13 (46.2%) excessive weight gainers at 6 months who continued DMPA use had gain even more weight (> 10% of their baseline weigh) at 12 months. Conclusions The majority of adolescent girls using DMPA had no excessive weight gain in 6 months. However, DMPA users who had excessive weight at 6 months were at high risk of gaining even more weight at 1 year.
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Affiliation(s)
- Preeyaporn Jirakittidul
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chotiros Somyaprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Angsuwathana
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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An exploratory survey on the state of training in adolescent medicine and health in 36 European countries. Eur J Pediatr 2019; 178:1559-1565. [PMID: 31463767 PMCID: PMC6733827 DOI: 10.1007/s00431-019-03445-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 11/11/2022]
Abstract
The development of adolescent health and medicine as a medical discipline lags behind in Europe compared with other regions of the world. This study aims to evaluate the structure and content of adolescent medicine and health training curricula for medical students, paediatricians, and other primary care physicians in the European region. A questionnaire survey was sent by e-mail to experts in the field from 36 European countries, addressing the content of adolescent health issues. Data was obtained from all 36 countries. At the undergraduate level, seven countries reported some mandatory stand-alone teaching (sessions dealing specifically with adolescents), while seven countries reported optional stand-alone teaching. In only 7 out of 36 countries were issues critical to adolescents covered as stand-alone sessions. At the postgraduate level, 15 countries delivered stand-alone mandatory training sessions to primary, secondary, or tertiary care paediatricians, covering most of the five critical areas listed in the questionnaire. In another 13 countries, such sessions were not mandatory and were inexistent in eight of them. The coverage among school physicians was similar but was much lower among general practitioners.Conclusion: Paediatric associations and academic institutions should advocate for a better coverage of adolescent health and medicine in the training curricula of health care providers. What is known: • In most European countries, adolescent medicine is still poorly represented as a discipline. • Experts have recently published recommendations regarding what form the structure and content of a training curriculum in this field should take. What is new: • This paper gives information on the extent and content of training in adolescent medicine and health as currently offered within under- and postgraduate European training curricula, in terms of stand-alone mandatory (versus optional) sessions. • In many European countries, both medical students and residents are poorly exposed to the basic knowledge and skills pertaining to adolescent health care.
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Hassan A, Maza JCR, Teich HG, Guerra EHC. Caring for adolescents in Guatemala: provider perspectives. Int J Adolesc Med Health 2017; 32:/j/ijamh.ahead-of-print/ijamh-2017-0121/ijamh-2017-0121.xml. [PMID: 28949929 DOI: 10.1515/ijamh-2017-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/13/2017] [Indexed: 06/07/2023]
Abstract
Purpose Today's generation of adolescents is the largest in history, creating a major challenge for low and middle income countries faced with the necessity of addressing their growing healthcare needs. Our objective was to assess the extent to which health care providers in Guatemala are trained, knowledgeable and feel comfortable providing services to adolescents. Methods A sample of 20 medical providers were recruited from the School of Medicine at San Carlos University and its affiliated hospitals. Providers were interviewed face-to-face for 30-40 min using a semi-structured guide exploring their training, knowledge, skills and experience in adolescent health care. Recruitment continued until thematic saturation was reached. Interviews were recorded and transcribed verbatim, and then analyzed for emergent themes using principles of framework analysis. Results The provider's mean age was 33.7 years [standard deviation (SD) = 10.2]. Most were female (65%) and practiced medicine in a metropolitan location. Results revealed the presence of five major themes: (1) Need for dedicated adolescent health services; (2) Presence of a multitude of barriers to providing adolescent health care; (3) Perceived comfort level in communicating with adolescents; (4) Limited knowledge of current adolescent specific services, programs, and guidelines; and (5) Gaps in medical education and training. Conclusion Providers recognize the need for increased and dedicated adolescent health care services. There is strong support for the creation of a credentialed national adolescent health training program.
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Affiliation(s)
- Areej Hassan
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue,Boston, MA, USA, Phone: 617-355-6334, Fax: 617-730-0184
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Juan Carlos Reyes Maza
- Hospital General San Juan de Dios, Guatemala City, Guatemala
- Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - Hayley G Teich
- Boston Children's Hospital, Deparment of Global Health, Boston, MA, United States of America
| | - Erwin H Calgua Guerra
- Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Lee L, Yehia BR, Gaur AH, Rutstein R, Gebo K, Keruly JC, Moore RD, Nijhawan AE, Agwu AL. The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth. AIDS Patient Care STDS 2016; 30:170-7. [PMID: 26983056 DOI: 10.1089/apc.2015.0263] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Limited data exist on how structures of care impact retention among youth living with HIV (YLHIV). We describe the availability of youth-friendly structures of care within HIV Research Network (HIVRN) clinics and examine their association with retention in HIV care. Data from 680 15- to 24-year-old YLHIV receiving care at 7 adult and 5 pediatric clinics in 2011 were included in the analysis. The primary outcome was retention in care, defined as completing ≥2 primary HIV care visits ≥90 days apart in a 12-month period. Sites were surveyed to assess the availability of clinic structures defined a priori as 'youth-friendly'. Univariate and multivariable logistic regression models assessed structures associated with retention in care. Among 680 YLHIV, 85% were retained. Nearly half (48%) of the 680 YLHIV attended clinics with youth-friendly waiting areas, 36% attended clinics with evening hours, 73% attended clinics with adolescent health-trained providers, 87% could email or text message providers, and 73% could schedule a routine appointment within 2 weeks. Adjusting for demographic and clinical factors, YLHIV were more likely to be retained in care at clinics with a youth-friendly waiting area (AOR 2.47, 95% CI [1.11-5.52]), evening clinic hours (AOR 1.94; 95% CI [1.13-3.33]), and providers with adolescent health training (AOR 1.98; 95% CI [1.01-3.86]). Youth-friendly structures of care impact retention in care among YLHIV. Further investigations are needed to determine how to effectively implement youth-friendly strategies across clinical settings where YLHIV receive care.
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Affiliation(s)
- Lana Lee
- Divisions of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Department of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly Gebo
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne C. Keruly
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard D. Moore
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ank E. Nijhawan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allison L. Agwu
- Divisions of Adult and Pediatric Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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