Adolescent Health Medicine and Therapeutics最新文献

Background: Indigenous children in Canada have high rates of obesity and type 2 diabetes mellitus (T2DM). Culturally appropriate interventions, guided by an Indigenous knowledge-based view of health, are crucial to target these conditions. The objective of this systematic review was to assess the impact of indigenous Knowledge-based lifestyle interventions on the prevention of obesity and T2DM in Indigenous children in Canada.

Methods: Database searches were conducted from inception until February 22, 2022. The main outcomes were changes in Body Mass Index (BMI) z-score and the development of T2DM. The other outcomes included adiposity, metabolic, and lifestyle determinants of health. The GRADE approach was used to assess confidence in the evidence.

Results: Four non-randomized controlled trials (non-RCTs) and six uncontrolled studies were identified. Peer-led interventions led to a reduction in BMI z-score and waist circumference. GRADE assessment revealed very low quality of evidence due to a lack of randomization and small sample sizes. There were no diabetes-specific reported programs.

Conclusion: Limited evidence from non-randomized studies suggest that peer-led indigenous Knowledge-based lifestyle interventions improve BMI z-score and central adiposity. There is a need for community-owned and adequately powered randomized studies for interventions that aim to treat and prevent obesity and T2DM in Indigenous children in Canada.

Systematic review registration: PROSPERO CRD42017072781.

Childhood, adolescent, and young adult (CAYA) cancer survivors are at risk of developing late effects associated with their cancer and its treatment. Survivors' engagement with recommended follow-up care to minimize these risks is suboptimal, with many barriers commonly reported. This scoping review aims to summarize the barriers to accessing follow-up care, using the dimensions of Levesque's framework for accessing healthcare. We retrieved quantitative studies addressing barriers and facilitators to accessing survivorship care in CAYA survivors from PubMed, EMBASE and CINAHL. Data was categorized into the five healthcare access dimensions outlined in Levesque's framework: i) approachability, ii) acceptability, iii) availability and accommodation, iv) affordability, and v) appropriateness. We identified 27 quantitative studies in our review. Commonly reported barriers to accessing care included a lack of survivor and provider knowledge of cancer survivorship, poor health beliefs, low personal salience to engage in follow-up care, high out-of-pocket costs and survivors living long distances from clinical services. Many studies reported increased barriers to care during the transition from paediatric to adult-oriented healthcare services, including a lack of developmentally appropriate services, lack of appointment reminders, and a poorly defined transition process. Healthcare-related self-efficacy was identified as an important facilitator to accessing follow-up care. The transition from pediatric to adult-oriented healthcare services is a challenging time for childhood, adolescent, and young adult cancer survivors. Optimizing CAYAs' ability to access high-quality survivorship care thus requires careful consideration of the quality and acceptability of services, alongside financial and physical/practical barriers (eg distance from available services, appointment-booking mechanisms). Levesque's model highlighted several areas where evidence is well established (eg financial barriers) or lacking (eg factors associated with engagement in follow-up care) which are useful to understand barriers and facilitators that impact access to survivorship for CAYA cancer survivors, as well as guiding areas for further evaluation.

The prevalence of pediatric obesity has increased exponentially over the past four decades. The American Academy of Pediatrics recently released updated clinical practice guidelines highlighting the importance of identifying pediatric obesity as a chronic disease. The guidelines support consideration of concurrent treatment with intensive lifestyle interventions, obesity pharmacotherapy, and bariatric surgery. The dramatic rise in pediatric obesity has spurred interest in utilizing obesity pharmacotherapy to support sustained weight reduction in pediatric cohorts, in the hopes of preventing the emergence of later-appearing, significant co-morbidities. Despite the enormous demand, the obstacles posed by performance of needed clinical trials in the pediatric population markedly limits available pharmacotherapy for the treatment of obesity in pediatrics. Currently, there are five medications approved by the Food and Drug Administration for use in youth with obesity. In 2022, the phentermine/topiramate (PHEN/TPM), once-daily, controlled-release, combination product received FDA approval, for the indication of chronic weight management, in youth with obesity, ages 12 years and older. The objectives of this narrative review are to: (1) Review the mechanism of action of phentermine and topiramate, (2) Summarize the safety and efficacy data of topiramate and phentermine use as both monotherapies and in combination, and (3) Discuss clinical practice guidelines and clinical implications, for the use of these agents in youths with obesity.

Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).

Background: Most adolescent mothers attend their first antenatal care (ANC) visit later than the recommended time while others do not receive good quality antenatal care (all the required components of ANC such as iron tablets). This study sought to examine the factors associated with timing of the first ANC visit and quality of ANC among adolescent mothers in Uganda.

Methods: This study was based on quantitative data from 248 adolescent mothers aged 10-19 years in Luuka district, Eastern Uganda. We selected adolescent mothers who were either pregnant or had infants aged 0-3 months. We used logistic regression to identify factors associated with timing and receipt of good quality ANC.

Results: The majority of the adolescents (82%) attended ANC for their most recent pregnancy. Of these, 47% made the first visit in the first trimester while 36% received good quality ANC. Having knowledge of danger signs in pregnancy was a determinant of both timing of first ANC visit (aOR = 2.89, 95% CI: 1.04-8.06) and receipt of good quality ANC (aOR = 6.57, 95% CI: 1.75-24.65). Other determinants for timing of first ANC visit were mother's age, partner's age, having ever given birth, decision maker on health care and daily earnings. Other determinants for quality of ANC included distance to health facility and knowledge of family planning methods.

Conclusion: This study recommends expanding the network of public health facilities further into the rural communities in the district as a means of bringing health services closer to adolescent mothers, deliberate efforts to equip adolescent girls with reproductive health information on pregnancy danger signs, and family planning and empowering adolescent girls to start income-generating activities.

Background: Birth through genocidal rape has a detrimental impact on the health of the offspring; however, there is scarce literature that focuses on efforts to support and reintegrate people born of this crime due to the lack of needs assessments that can inform policies and interventions.

Objective: This study sought to explore perceptions of the intervention utility and effectiveness in supporting and reintegrating offspring born of the 1994 genocidal rape against the Tutsi in Rwanda.

Methods: A purposive sample of 16 dyads of non-partnered mothers raped in the 1994 genocide against the Tutsi and their offspring participated in semi-structured qualitative interviews. The transcribed interview verbatims were uploaded to NVivo 12 and analyzed inductively using thematic analysis.

Results: The analysis resulted in several subthemes that were grouped into four main themes based on research questions. These themes included the reconstruction of a positive image (ie, hardworking, contribution to the community, supporting vulnerable people, etc.), the benefits of collaborating with peers in a similar situation (ie, a sense of belonging, self-acceptance, relieving distress and emotional pain, etc.), the support obtained from Survivors Fund Rwanda (ie, psychosocial support, financial support for school fees, support to get a job), and the intervention and strategies needed (ie, continuous psychosocial support, catch-up learning programs, accompaniment support, advocacy to get a job, supporting the parents, etc.).

Conclusion: Our results highlight how the youth born of genocidal rape are reconstructing a positive image and self-advocacy, their perception of obtained support, and the recommended intervention. These findings will help in initiating or strengthening interventions targeting this population, especially strategies to support and reintegrate them.

Background: Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. We determined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13-17 years in Agago district, Uganda.

Methods: We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13-17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semi-structured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant.

Results: A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7-100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5-71.9, p=0.02).

Conclusion: The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.

This review aimed to synthesize the minimal existing literature on the impact of perceived stigma on self-disclosure patterns among children and youth with epilepsy (YWE). Initial literature searches were conducted in PsycInfo, Scopus, Web of Science, and PubMed using search terms focused on epilepsy, pediatrics, disclosure, and/or stigma. Articles were included if they were original human research articles published in peer-reviewed journals that were accessible in English through Cincinnati Children's Hospital Medical Center Pratt Library and fit study aims. Thirteen articles, which primarily used qualitative self-report methodologies, fit the study's inclusion criteria. YWE report greater perceived stigma and lower illness disclosure compared to youth with other chronic health conditions. Across studies, perceived stigma was consistently identified as a barrier to YWE disclosing their epilepsy diagnosis. Consequences of perceived stigma included lower self-esteem, poorer perceived competency, lack of self-confidence, social withdrawal, and lower quality of life. YWE's reluctance to disclose epilepsy was associated with worry about differential treatment, negative impact on close relationships, negative impact on others' perceptions, and negative self-perceptions. While WHO and ILAE have identified stigma as contributing to higher disease burden in people with epilepsy and have highlighted the importance of prioritizing social policy focused on decreasing epilepsy-related stigma, progress has been incremental and much work remains. Future research is needed to understand socio-cultural factors perpetuating stigma among YWE in order to further develop, evaluate, and disseminate evidence-based clinical and education programming to combat epilepsy-related stigma.

This paper reviews the current understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whether any treatment strategies have been effective. ME/CFS is a condition of as yet unknown etiology that commonly follows an infective process. It includes a new onset of fatigue (of more than 3-6 month duration and not relieved by rest), post-exertional malaise, cognitive difficulties and unrefreshing sleep, and frequently orthostatic intolerance, somatic symptoms and pain. Long COVID has renewed interest in the condition and stimulated research with findings suggestive of a multisystem neuroimmune disease. There are no definitively effective treatments. Despite earlier recommendations regarding graded exercise therapy and cognitive behavior therapy, the current recommendations are managing symptoms, with lifestyle management and supportive care. This paper provides an outline of strategies that young people and their families have reported as helpful in managing a chronic illness that impacts their life socially, physically, emotionally, cognitively and educationally. As the illness frequently occurs at a time of rapid developmental changes, reducing these impacts is reported to be as important as managing the physical symptoms. Young people face a mean duration of 5 years illness (range 1-16 years) with a likely residual 20% having significant restrictions after 10 years. Their feedback has suggested that symptom management, self-management strategies, advocacy and educational liaison have been the most helpful. They value professionals who will listen and take them seriously, and after excluding alternative diagnoses, they explain the diagnosis, are supportive and assist in monitoring their progress. Remaining engaged in education was the best predictor of later functioning. This allowed for social connections, as well as potential independence and fulfilling some aspirations. The need to consider the impact of this chronic illness on all aspects of adolescent development, as part of management, is highlighted.