The origins, development, and goals of adolescent medicine

The status of adolescent medicine: building a global adolescent workforce

Remarkable public health achievements to reduce infant and child mortality as well as improve the health and well-being of children worldwide have successfully resulted in increased survival and a growing population of young people aged 10-24 years. Population trends indicate that the current generation of 1.8 billion young people is the largest in history. However, there is a scarcity of dedicated resources available to effectively meet the health needs of adolescents and young adults worldwide. Growing recognition of the pivotal roles young people play in the cultures, societies, and countries in which they live has spurred an expanding global movement to address the needs of this special population. Building an effective global workforce of highly-skilled adolescent health professionals who understand the unique biological, psychological, behavioral, social, and environmental factors that affect the health of adolescents is a critical step in addressing the health needs of the growing cohort of young people. In this review, we aim to: 1) define a global assessment of the health needs for adolescents around the world; 2) describe examples of current training programs and requirements in adolescent medicine; 3) identify existing gaps and barriers to develop an effective adolescent health workforce; and 4) develop a call for targeted actions to build capacity of the adolescent health workforce, broaden culturally relevant research and evidence-based intervention strategies, and reinforce existing interdisciplinary global networks of youth advocates and adolescent health professionals to maximize the opportunities for training, research, and care delivery.

[Historical aspects of the institutionalization of adolescent healthcare in the state of São Paulo, 1970-1990]

The article explores historical aspects of integral healthcare for adolescents in the state of São Paulo, particularly in regard to the implementation of pioneering services and programs. Against the backdrop of Brazil's social and political context during this period, it contextualizes the challenges, clashes, and difficulties that arose within the institutions involved in developing this field, from the perspectives of clinical medicine and of collective health. Grounded on documental material, the study re-examines the construction of groups of expertise and of the field of adolescent health care as part of the dialectical interplay between the construction of a new area of medical practice based on clinical work and a field of knowledge and practices in collective health based on integral health care of an interdisciplinary, inter-sectoral nature.

Adolescent health care in a teaching service: the point of view of the patients

The study compared adolescents' expectations before medical consultations with their opinions obtained after the consultations and identified features related to satisfaction with medical care provided by medical students.

METHODS

We carried out a cross-sectional study in a primary health care service from a medical school in Brazil. Assessment instruments: before and after consultation questionnaires. Studied variables: age, gender, reasons for seeking medical care, expectations, comfort, perception, opinion, satisfaction, and the intention to come back for another consultation. We used qui-square tests, and the significance level was set at 0.05.

RESULTS

First, the adolescents did not differentiate the treatment, reporting discomfort. Despite this, they reported good expectations. After consultation, they could distinguish the students from physicians, realized the specificity of the treatment, and indicated high levels of satisfaction, as well as positive experiences regarding health care provided by the students.

International developments in adolescent health care: a story of advocacy and achievement

The contemporary health problems of young people occur within the context of the physical, social, cultural, economic, and political realities within which they live. There are commonalities and differences in this context among developed and developing countries, thus differing effects on the individual's personal as well as national development. Internationally, the origins and evolution of health care for adolescents can be viewed as an unfolding saga taking place particularly over the past 30 years. It is a story of advocacy and subsequent achievement in all corners of the world. This paper reviews the important developments in the international arena, recognizes major pioneers and milestones, and explores some of the current and future issues facing the field. The authors draw heavily on their experiences with the major nongovernmental adolescent health organizations. The special roles of the World Health Organization, Pan American Health Organization, and United Nations Children's Fund (UNICEF) are highlighted, and special consideration is given to the challenge of inclusion through youth participation.

The history of adolescent medicine

The field of adolescent medicine is unique as a subspecialty in that the practice of providing care to teenagers has always been viewed historically as a responsibility of generalists. Scientific advances in subspecialty fields such as endocrinology, gynecology, gastroenterology, infectious disease, and sports medicine were incorporated with considerable success into the general practices of not only pediatricians but also internists and family practitioners. However, societal changes in the past century began to shape the way health professionals thought about adolescents and their families and significantly influenced the practice of providing health care to adolescents. The most notable change, however, was the shift from the traditional role of providing anticipatory guidance to parents toward a reduction of risk-taking behaviors aimed directly at the adolescent. The subspecialty of adolescent medicine thus emerged as an amalgam of researchers, clinicians, and educators, who, through a variety of settings, hoped to advance science, moderate public and social policy, improve health care, and stimulate health promotion to this special population of patients.

Comprehensive health care for high-risk adolescents: an evaluation study

This study was designed to evaluate the effectiveness of a large scale program to improve health care for high-risk adolescents. Seven clinics, funded to provide comprehensive primary care to adolescents, were compared to three non-funded clinics. The majority of the 2,788 adolescent patients sampled in these clinics were female (78 percent) and Black (71 percent). Each patient was initially interviewed at the time of a clinic visit and reinterviewed 12 months later; their medical records were systematically reviewed. As expected, the funded clinics detected and treated a wider range of medical and behavioral problems than the comparison clinics, a finding that was based on the self-reports of patients and confirmed by documentation in the medical records. However, improvements in life-style and in specific medical outcomes were not observed. To build on the limited success of this program, efforts are needed to encourage more males to receive care and to develop more specific interventions for patients in this age group.

Career satisfaction in adolescent medicine. A survey of physicians trained over a 20-year period

National data are available on the career undertakings of those trained in adolescent medicine, but longitudinal data on actual career and job satisfaction is lacking. Forty-five physicians trained in adolescent medicine from 1965 to 1985 at a large urban teaching hospital were surveyed using the Jewitt/Greenberg Career Satisfaction Questionnaire. Thirty two (71%) responded. Twenty-one (66%) were primarily in practice, eight (25%) were in academic medicine, and three (9%) were involved in administration. Five (16%) had careers in adolescent and/or young adult health care. Thirty-one (97%) claimed to at least "like" their career, and 29 (91%) felt "satisfied." Only three (9%) desired to change their career, but 11 others (34%) stated they would if they could have an equal opportunity in a new career. Four individuals (13%) would not have chosen medicine if given another chance, and 12 (30%) would not have chosen pediatrics. Greatest satisfaction was derived from patient care activities (62%), the actual work site and job (50%), and finances (40%). Dissatisfaction resulted from too little money (34%), inadequate time (25%), administrative problems (22%), and patient-related problems (22%). A large majority (72%) desired to be acknowledged as specialists. This review of graduates from a single program provides a unique perspective on the ultimate careers of trainees. A similar review of other programs may help facilitate teaching and correct programatic deficiencies. This review also suggests that careful thought should be given to a way of properly acknowledging, as specialists, those trained in adolescent medicine.