The role of ovarian volume in reproductive medicine. (1/49)

The human ovary is a dynamic organ which continually changes in size and activity through life, as an integral part of the changes that the female is going through before during and after her reproductive life. Following the rapid increase in the use of transvaginal scan in recent years, the measurement of ovarian volume has become quick, accurate and cost-effective. Ovarian volume is an important tool in the screening, diagnosis and monitoring the treatment of conditions such as polycystic ovarian syndrome, ovarian cancer and adolescent abnormalities. In reproductive medicine, measurement of ovarian volume has a role in the assessment of ovarian reserve and prediction of response to superovulation.  (+info)

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group. (2/49)

BACKGROUND: Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. METHODS: A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. RESULTS: Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. CONCLUSIONS: This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.  (+info)

Clinical holistic medicine: holistic adolescent medicine. (3/49)

The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine--giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs--is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient. A deeper insight into the principles of holistic treatment and a thorough understanding of our fellow human beings are making it work even better. Holistic medicine is not a miracle cure, but rather a means by which the empathic physician can support the patient in improving his/her future life in respect to quality of life, health, and functional capacity--through coaching the patient to work on him/herself in a hard and disciplined manner. When the patient is young, this work is so much easier. During our lifetime, we have several emotional traumas arranged in the subconscious mind with the smallest at the top, and it is normal for the person to work on a large number of traumatic events that have been processed to varying degrees. Some traumas have been acknowledged, some are still being explored by the person, and yet others are still preconscious, which can be seen for example in the form of muscle tension. Sometimes the young dysfunctional patient carries severe traumas of a violent or sexual nature, but the physician skilled in the holistic medical toolbox can help the patient on his/her way to an excellent quality of life, full self-expression, a love and sex life, and a realization of his/her talents--all that a young patient is typically dreaming about. Biomedicine is not necessary or even recommended when the physical or mental symptoms are caused by disturbances in the personal development that can be corrected with love and understanding. If possible, biomedicine must be avoided, even if this means suffering for the young person, who needs to confront the tough realities of life in order to grow into an able and sound adult.  (+info)

Adolescent health care in a large multispecialty prepaid group practice. Who provides it and how well are they doing? (4/49)

Adolescents are at risk for pregnancy, sexually transmitted diseases, suicide, homicide, accidents, and substance abuse. Adolescent medicine involves an overlap of many skills needed to provide routine medical care, as well as care for those conditions that require psychosocial assessment. We report the results of a mail survey covering care of this age group by practitioners of pediatrics, internal medicine, obstetrics and gynecology, family practice, and adolescent medicine in a large, multispecialty, prepaid group practice. The mail survey covered 10 areas of adolescent care. Adolescent medicine physicians expressed the highest level of perceived knowledge and competence in these areas, with family practitioners ranked second. More than 50% of internists and pediatricians felt only fair to poor competence for a variety of adolescent conditions, whereas a third of internists and pediatricians reported that they liked to care for adolescents. Physicians in all 4 of the primary care specialties reported a need for a teen health center for both consultation and education. These results are similar to those reported for pediatricians and primary care physicians in private practice and for residents in internal medicine.  (+info)

Curbing adolescent smoking: a review of the effectiveness of various policies. (5/49)

Tobacco-related mortality is one of the biggest killers in American medicine. Evidence suggests that if adolescents can be kept tobacco-free, most will never start using tobacco. Therefore, tobacco control policies directed at the youth population could provide an effective method for sustaining long-term reductions in smoking in all segments of the population. Many forms of tobacco control policies have been implemented including restrictive laws, public campaigns, and taxation duties; there has been disagreement over which is most effective. We investigate the efficacy of various methods of tobacco control in youth and present a review of the published evidence. Econometric data for both youth access restrictions and environmental tobacco smoke restrictions afford ambiguous results. Results vary in a continuum from a moderate negative effect toward, ironically, a marginal positive effect on smoking. While information dissemination policies may be somewhat effective on the onset, they are limited in their effect and eventually diminish over time. We conclude that increases in price affect teen smoking to a great degree. Most estimates show that for a 10 percent increase in prices, which could be implemented by a tax per pack, a 15 percent decrease in cigarettes consumed could be accomplished. Taxation policies are an effective means of preventative medicine.  (+info)

Changing parental opinions about teen privacy through education. (6/49)

OBJECTIVE: Confidentiality for adolescent patients is the standard of care. However, some parents object to this practice. We determined the prevalence of parents who have negative opinions regarding adolescent privacy policies and education's effect on that prevalence. METHODS: All parents who sought care for their teen at 2 adolescent medicine clinics were asked to complete a computer survey about teen privacy and risk-taking behavior. Parents who did not know the clinic's privacy policy or had never been to the clinic were asked to participate in an educational study. Study participants were randomly selected to receive education by a handout or a scripted face-to-face encounter. They were surveyed again the same day. For evaluating long-term retention, a follow-up survey was conducted at least 30 days after the education. RESULTS: A total of 563 parents were surveyed. Of 281 eligible parents, 130 (46%) completed the postintervention survey and 52 (19%) completed the follow-up survey. Repeated measures analysis of variance showed that both education types were equally effective in teaching parents chosen privacy facts. The average number of correct test questions increased from 58.6% to 89.1%. More than 30 days later, the parents' score was 86.9%. Before education, 35% disagreed or strongly disagreed with teens' having private information, compared with 13.8% immediately after education and 15.4% at follow-up. The percentage of parents who disagreed or strongly disagreed with providers' seeing the patient alone was 30.5%, which decreased to 14.5% after education and 17.3% with the follow-up survey. Chi2 tests showed no statistically significant differences between face-to-face and written education in changing parental opinions regarding privacy. When an adolescent wanted to speak with a provider alone, 93% of the parents agreed with that choice, regardless of intervention. CONCLUSIONS: This study identifies that almost one third of the parents who presented to these adolescent medicine clinics had negative opinions about some privacy practices. The 2 main issues were teens' seeing a provider alone and providers' keeping information confidential. Education was effective in teaching parents about privacy issues and produced a significant improvement in parental opinion about confidentiality. Simultaneously, an overwhelming majority of parents support the idea that teens should speak with a provider alone if the teen so desires, suggesting that parents acknowledge a need for independence. Providing confidential services is an essential part of adolescent health care that works best with the alliance of parents. This study supports the continued need to assess parental attitudes about privacy issues and to provide parents with education.  (+info)

Adolescent medicine in paediatric practice. (7/49)

Adolescents are a growing area in paediatric practice in both hospital and community settings. They make up around one quarter of the practice of many paediatricians. Yet until recently there has been little formal interest in young people's health in the UK. The situation is now changing, particularly following the publication of the "National Service Framework for children, young people and maternity services", which places a major emphasis on adolescent health. Given that this area is relatively new to many paediatricians, this article aims to provide an overview of the range of health problems that affect young people, to provide practical advice for working with this group in paediatric practice, and to outline current and future opportunities for training in adolescent health in the UK.  (+info)

Sexually transmitted disease prevention in adolescents and young adults. (8/49)

OBJECTIVE: Sexuality is one of the most pervasive aspects of the human life cycle. It warrants attention in childhood, adolescence and adulthood, and is an integral part of each health maintenance visit. Given this, it is unfortunate that U.S. medical schools do not offer more training in soliciting sexual histories and initiating dialogue about sexually healthy lifestyles. METHODS: Fourth-year medical student completed an adolescent and young-adult sexually transmitted disease elective. RESULTS: This elective allows medical students to confront personal biases and discomfort levels yet remain objective. It is also an opportunity to explore how the provider's body language and facial expressions can discourage information disclosure. Although sexuality is very prevalent in our society today, patients may still be apprehensive about discussing details of their sexual practices. Therefore, it becomes incumbent upon the physician to create an environment free from personal prejudice in order to best serve the patient. CONCLUSIONS: In order to promote sexual health awareness in a society that can be conservative and judgmental in this subject matter, it is essential to train all healthcare providers to lead discussions, educate patients and provide treatment in hopes that sexual health promotion will become as important as other socially accepted healthcare concerns.  (+info)