Ambulatory Child Health最新文献

Background Multi-agency approaches based on assessment of local need have been recommended to reduce the incidence of teenage pregnancy. This paper explores the views of local teenagers on current and future provision of sexual health services in one part of Leicester, UK.

Aim To examine current provision and the views of teenagers on how these could be improved.

Method A questionnaire was developed from literature review and focus group interviews. It was administered to 13–16-year-olds in two schools, and by post to 16–19-year-olds, using the age-sex registers of five of the seven local practices.

Results Of the 399 school attenders aged 13–16 years sampled, 394 (98.7%) completed the questionnaire. The postal questionnaire was sent to 1255 teenagers aged 16–19 years. After removal of wrong addresses, the response rate was 317 of 1213 (26.1%). In total, 711 people completed the questionnaire, of whom 459 (64.6%) were male. General practitioners and pharmacists were the main suppliers of contraception for females and males, respectively, with lack of awareness of the range and location of sexual health services. Major barriers included fears about embarrassment, confidentiality and being examined, especially in general practice.

Conclusions Our results suggest that in this locality, the priority should be informing teenagers about existing services, and ensuring confidentiality is both practised and publicised. A leaflet to this effect has been produced and disseminated.

Implications for practice Qualitative and quantitative methods are helpful in assessing local need for teenage services and in directing their development.

Objectives To test whether a child health record designed for preschool children with a disability would: (a) be used; (b) be valued by carers; (c) change the perception of the health care received by the child; or (d) influence the amount of communication between the family and a professional who is seeing their child.

Methods Ninety-nine families participated, and of these, 67 received the record as the intervention and 32 were controls. After use, copies of the record were examined, and carers completed a satisfaction questionnaire. The families were randomized into three groups for two-phase controlled questionnaire studies to measure changes in the families' perception of their child's health care and the degree of communication between the family and the professional.

Results Satisfaction questionnaires were returned by 53 (79%) of those who received a record, and most of the responses were favourable. Of the 39 (58%) who returned copies, nearly all had made some use of the record, and 24 had made entries in its diary section. There was no accompanying change that could be measured in the perception of the child's health care or in the amount of communication between families and professionals.

Conclusions Those who participated in this small study appreciated the new disability section added to the standard child health record. Copies returned for inspection had nearly all been used. The lack of a detectable change in the family's perception of their child's health care or in communication between families and professionals suggests that the value of the record is limited to its use as an aide-mèmoire.

Background With recent progress in controlling HIV disease in children, infected children are living longer than ever before. Their health care needs include health supervision services, such as developmental monitoring and anticipatory guidance, which are best provided by child health providers (Providers). Providers need to know about the care of children with HIV infection in order to provide optimal health supervision services.

Objective To design a curriculum to educate providers about the care of children with HIV infection, targeted to the needs of local providers.

Setting The primary care centre of an urban children's hospital in Connecticut during 1997–98.

Intervention We observed clinical cases; conducted a needs assessment, including discussions with providers and a review of educational resources; and held discussions with infectious disease subspecialists. From these, we designed a series of seminars covering individual topics generated mainly by providers. We then conducted a grand rounds lecture to cover the topics more broadly. All participants received a booklet covering the topics discussed.

Impact Providers received the sessions well. Self-reporting suggested changes in their care of children with HIV infection, including increased confidence in decision-making about routine health issues, more aggressive immunization, and better coordination of care with subspecialists. Many suggestions for further sessions were generated.

Conclusion An educational program tailored to the needs of local child health providers may be helpful in the care of their patients with HIV infection. This program can promote high-quality, co-ordinated care for the complex needs of these patients.