Adolescent Health Medicine and Therapeutics最新文献

Background: Adolescence is typically seen as a "healthy" period in a person's life, free from illness. The World Health Organisation (WHO) estimates that 1.7 million adolescents die every year because of preventable causes such as suicide, injuries, and violence. The aim of this quality improvement initiative was to assess and improve the use and documentation of the psychosocial risk assessment tool; HEEADSSS, amongst non-consultant hospital doctors (NCHDs) in a paediatric tertiary centre emergency department (ED).

Methods: This was a mixed method quality improvement initiative carried out over three phases in paediatric tertiary centre ED. Educational interventions were implemented and their efficacy assessed.

Results: There was a 277% (n = 9 increased to n = 34) improvement in the use and documentation of HEEADSSS in the post intervention phase of the study. Participants who had undertaken the intervention were significantly more likely to have either a partially or fully completed HEEADSSS assessment compared to those who had not (odds ratio [OR] = 5.24, 95% confidence interval [CI]: 3.45-7.75, p < 0.001; n = 409). Additionally, the odds of having a fully completed HEEADSSSassessment were significantly higher among those who received the intervention (OR = 4.08, 95% CI: 1.90-8.75, p < 0.001; n = 409). Clinical presentations synonymous with psychosomatic illness, such as chest pain, abdominal pain and headaches were more likely to have a HEEADSSS done following the intervention phase.

Conclusion: The results demonstrate the efficacy of simple, accessible and education focused interventions. There is little documented in current literature about the efficacy of a proforma. In the field of adolescent medicine, there is a call for a multi-sectorial approach to be adapted, encompassing the educational, emotional, and financial needs of adolescents. Global health promotion strategies need to adjust to a prevention paradigm, focusing on the origin of adult mortality.

Purpose: To assess the predictors of Chinese parents of girls' decision stage about the Human Papillomavirus (HPV) vaccination.

Patients and methods: Two hundred and seventy-three parents of girls aged 9-17 with no HPV vaccination history were recruited to complete an online survey between September-December 2023. We assessed factors thought to influence decisions about HPV vaccination, including sociodemographics, HPV general knowledge, HPV vaccination knowledge, attitudes, and decisional conflict. Parents were asked to choose the decision stages among Stage 1 (have not thought), Stage 2 (considering), and Stage 3 (decided). Predictors of the decision stage were assessed with univariate and multivariate multinomial logistic regression.

Results: The parents of the three decision stages accounted for 48.4%, 29.7%, and 22.0%, respectively. Parents of older girls were more likely to be in the "considering" stage (OR = 1.29) than the "haven't thought" stage. A higher sense of being uninformed was associated with lower odds of being in the "considering" stage (OR = 0.97). Additionally, greater feelings of uncertainty were linked to lower odds of being in the "decided" stage (OR = 0.95) than the "haven't thought" stage.

Conclusion: This study highlights the importance of understanding the various stages of decision-making in HPV vaccination among Chinese parents. Parents' subjective feelings of being informed and certainty appear to be significant factors in advancing through the decision-making stages. Future research should develop and explore the impact of specific knowledge and valued based tools and decision aids.

Background: The COVID-19 pandemic has escalated the utilization of virtual care platforms in pediatric diabetes mellitus. The impact of these interventions on the health-related quality of life (HRQOL) is unclear.

Objective: This systematic review evaluated the impact of virtual care, including eHealth and mHealth modalities, when compared to in-person care, on HRQOL in children with diabetes.

Methods: MEDLINE, EMBASE, EMCare, PsycInfo, and Web of Science, ProQuest Dissertations and Theses A&I, and ClinicalTrials.gov databases and registries were searched from database inception to October 2^nd, 2023. Randomized and non-randomized comparative studies were eligible for inclusion.

Results: Thirteen studies were identified (12 randomized controlled trials, 1 cross-sectional study) involving 1566 children with type 1 diabetes mellitus (T1DM). The supplemental virtual care interventions utilized either web- or mobile-based platforms for intervention implementation. No interventions were detrimental to HRQOL, and a few improved the short-term HRQOL. No interventions worsened glycemic control. Patients and family's satisfaction with virtual care was high, perceiving it to be equal to or better than in-person care. There was no evidence for the use of virtual care and its effect on HRQOL in pediatric type 2 diabetes mellitus patients.

Conclusion: Virtual care is associated with a stable or improved HRQOL and patient and family satisfaction in pediatric T1DM. Decision makers need to consider expanding virtual access to pediatric diabetes care that can improve equitable access to quality care across healthcare systems globally.

Background: Teenage pregnancy rates have globally decreased over the years, but remain high, especially in low- and middle-income countries (LMICs). Among girls aged 15-19, teenage pregnancy remains the leading cause of death and a significant barrier to education and productivity. Its prevalence was high in pakwach district as reported by the DHO and police report during the pandemic. However, limited data exist regarding factors contributing to its rise during the COVID-19 pandemic in Uganda. This study explores the factors associated with teenage pregnancy in Pakwach district during this period.

Methods: We conducted a matched case-control study, enrolling 362 teenage girls aged 10-19 years, divided into two groups: 181 pregnant teenagers and 181 non-pregnant teenagers. We collected exposure data from both groups using a questionnaire to assess factors associated with teenage pregnancy. The study period covered March 2020 to January 2021, coinciding with lockdown measures.

Results: During the COVID-19 period, teenage pregnancies were only associated with having exclusively female peers (AOR 3.0, 95% CI: 0.1-104.4). Conversely, having a Radio/TV at home (AOR 0.2, 95% CI: 0.1-0.6), age at first sexual encounter (AOR 0.1, 95% CI: 0.03-0.9), considering teenage pregnancy as sexual abuse (AOR 0.1, 95% CI: 0.02-0.4), feeling comfortable asking questions during consultations (AOR 0.5, 95% CI: 0.2-1.3), and ensuring sufficient privacy during consultations were protective against teenage pregnancy.

Conclusion: The factors contributing to increased teenage pregnancies during the COVID-19 pandemic were consistent with long-standing contextual factors associated with teenage pregnancy. The lockdown environment may have slightly exacerbated these factors, but no direct association was observed. Only having female peers was linked to teenage pregnancy during the lockdown. But more importantly for our study population, having access to a radio/TV at home and other healthcare system-related factors were protective during the lockdown. Therefore, interventions should be focused on making pregnancy prevention information available to teenagers during any lockdown scenario.

African immunization programs are crucial in reducing the prevalence of infectious diseases and improving public health outcomes. This review provides an overview of the current status of immunization efforts in Africa, highlights key challenges, and offers recommendations to help the continent achieve the 2030 Global Immunization Goals. While progress has been made, significant challenges remain. For instance, the WHO African Region reports full immunization coverage at 56.5%, partial coverage at 35.1%, and zero immunization coverage at 8.4%. Between 2019 and 2021, approximately 67 million children in Africa did not receive routine vaccinations, with West and Central Africa particularly affected. DTP1 coverage remained stable at 80%, but DTP3 coverage saw a slight drop to 72% between 2021 and 2022. As of 2022, MCV1 coverage reached 69%, reflecting ongoing efforts against measles. Key barriers to vaccination include limited parental education, religious beliefs, inadequate healthcare systems, and vaccine hesitancy. Addressing these barriers requires community-driven approaches like door-to-door campaigns and mobile clinics. To reach the 2030 immunization targets, health systems must be strengthened, vaccine supply chains optimized, and financial resources-both domestic and international-expanded. The Immunization Agenda 2030 (IA2030) emphasizes data-driven decision-making, nation-ownership, and tailored strategies to overcome obstacles and raise immunization coverage among several demographic groups. Achieving these 2030 goals in Africa requires collaborative efforts to ensure equitable access to vaccines, address sociocultural challenges, and strengthen health system infrastructure.

Background: Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage.

Objective: To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs.

Methods: This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective.

Results: Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs.

Conclusion: As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.

Introduction: Existing research on medical cannabis patients has often overlooked those younger than 21. This study aimed to detail the frequency and rate of pediatric medical cannabis patients in the US using a large patient database.

Methods: Utilizing Leafwell Patient Database data from 2019 to mid-2023, we described demographics and qualifying conditions, employing descriptive statistics and χ2 tests to discern differences between minors (0-17 years) and young adults (18-20 years). We calculated rates per 100,000 population by state.

Results: Analyzing 13,855 patients, 5.7% were minors and 94.3% were young adults. Anxiety emerged as the primary self-reported condition for both groups, yet differences were seen for other conditions. Differences were observed by race/ethnicity, health insurance status, residency in adult-use states, and number of reported conditions. Notably, both groups reported a similar average number of conditions.

Conclusion: This study underscores demographic distinctions between minor-aged medical cannabis patients and young adults. There is a need for comprehensive clinical research addressing efficacy, safety, and tailored guidelines specific for pediatric medical cannabis patients. Such insights are pivotal for healthcare providers and policymakers in navigating medical cannabis treatment protocols.

Introduction: Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State.

Methods: A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software.

Results: The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents.

Conclusion: The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.

Cystic fibrosis (CF) is a multisystem disorder that occurs as a result of autosomal recessive congenital transmission of CF transmembrane conductance regulator (CFTR) gene mutation on chromosome 7. Because it is considered a disease of the Caucasian pediatric population or due to lack of awareness, it is rarely considered in developing countries like ours. This case report presents the first case of cystic fibrosis ever reported in Ethiopia and possibly East Africa, that of a 17-year-old female diagnosed with the disease following a CT scan of her abdomen and chest. She was initially misdiagnosed and treated for tuberculosis (TB) as she was a chronic cougher. Perhaps due to epidemiological evidence, there is an obstinate tendency of blaming tuberculosis (TB) for almost every case of chronic cough with fibro-bronchiectatic lung parenchymal changes in Ethiopia. Once a diagnosis of TB is posted on such patients, their diagnosis remains in the circle of TB reinfection, relapse or resistance, followed by multiple phases of anti-mycobacterial drugs. This could lead to hazardous implications, including unnecessary prolonged anti-mycobacterial treatments, possibility of developing drug resistance, and mismanagement-related patient morbidity. This patient's chest and abdominal CT findings, including bronchiectasis, hepatic steatosis, pancreatic lipomatosis, micro-gallbladder and proximal colonic wall thickening, led to the diagnosis of CF. This article, presenting the first documented case of CF in the region, is meant to be a helpful reminder for clinicians and radiologists to also consider presumably "rare" illnesses like CF rather than blaming TB for every chronic cough and highlights the importance of abdominal CT features in the diagnosis of CF.

Background: Although access to sexual and reproductive health information is the right and a critical component of health policy, it is not well addressed in pastoral communities. This study assessed the effect of School-Lined Module-based friendly health education on adolescents' sexual and reproductive health knowledge in the pastoral community of Guji Zone, Ethiopia.

Methods: A two-arm cluster Randomized control trial study with pre-post evaluation was conducted among interventions (n=375) compared with control (n=384) in Gorodola and Wadara high schools. Comparing an intervention to a control group, pre-posttests, and post-posttests were used to evaluate the effectiveness of the intervention. The data was collected using 25 Self-administered questionnaires and analyzed using paired-sample independent t-tests and linear regressions to study the relationship between the outcome and independent variables.

Results: We collected the data from 759 adolescents among 15 intervention and 15 control clusters. The results have shown that as compared to control arms, the mean sexual and reproductive health Knowledge score was significant higher in the intervention clusters (375) 73.3%, vs (384) 66.5%%, p<0.001, 95% CI, (0.05395-0.08347). Information (β: 0.038, 95% CI: 0.028-0.052), confidence (β: 0.045, 95% CI: 0.033-0.057), knowledge (β: 0.05, 95% CI: 0.035-0.066), and compassionate care (β: 0.107, 95% CI: 0.092-0.122) were significantly associated with SRH knowledge prediction. The proportion of SRH knowledge increased from 168(44%) baseline to 244(65%) end line in the intervention versus 235(60% to 238(62%) in control arms.

Conclusion: The execution of school-linked module-based friendly health education has proved to have a significant effect on mean SRH knowledge. Individual-level and behavioral-level factors significantly explain variability in enhancing SRH knowledge in the pastoral community. We recommend scaling up the School-Linked Module-based friendly health education intervention.

Trial registration: We registered clinical trial PACTR202107905622610 on 16 July 2021.