Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial

The person-centered medical care in pediatrics: A scoping review

INTRODUCTION AND OBJECTIVES

The medicine development demonstrates that the traditional bioethical medical care model is not the most adequate. On the other hand, the person-centered clinical method has been winning more space in the medical practice, since it is a humanized method of care that allows best results. In pediatrics, the patient-centered care works a little bit different, since it requires not only the physician-patient relation, but also the integration of the physician-family-patient relation. Thus, the patient-centered care in the pediatric area is understudied, as well as little practiced. In this context, this review has the objective to exposure the actual scenario of the patient-centered care in pediatrics.

MATERIALS AND METHODS

This is a scoping review carried out from the standards of Jonna Briggs Institute (JBI). The database PubMed, Science Direct and BVS were used to search studies between 2012 until 2024. The research was performed with the descriptors "Medicine", "Shared DecisionMaking", "Pediatrics", "Physician-PatientRelations" and "Patient-CenteredCare".

RESULTS

The research identified 27,272 articles, along with 79 met the criteria and were included. Each article was analyzed and allocated in the four pillars of the patient-centered care, which was described and related with the pediatric clinic.

CONCLUSIONS

The patient-centered care brings benefits to medical care, especially in the pediatric area. Among them, stands out the increased adherence to treatment, the lowest rates of medical errors, the greater integration of the interprofessional team, the more individual and patient-sensitive investigation, as well as the respect of beliefs and desires, making the results obtained better.

Advancing adolescent health promotion in the digital era

Adolescents globally are calling for high-quality digital services to support and improve their health and well-being. Digital technologies are playing an increasing role in healthcare and whilst today's adolescents have been exposed to digital media since birth, there are unique challenges to their use that must be considered. This review aims to synthesize the literature on adolescent health promotion in the digital era. It provides evidence from adolescent perspectives and identifies that community-based and 'digital only' settings hold scope for further research to advance the field. The article recommends that when working with adolescents to develop digital health promotion tools, we should look to use youth engagement frameworks that are relevant to their context. Secondly, it demands stronger governance over digital media to protect adolescents, whilst allowing safe digital access. Finally, it demonstrates how listening to adolescents may help to address the emerging digital determinants of health and avoid exacerbating health disparities. Adolescents are powerful advocates to make global change. Stakeholders across research, policy and practice should examine how they incorporate adolescent voices to drive change in health promotion in the digital era.

Digital dietary interventions for healthy adolescents: A systematic review of behavior change techniques, engagement strategies, and adherence

BACKGROUND

Adolescence is a crucial phase for developing healthy eating habits with lifelong health implications. Digital interventions, such as smartphone apps and web platforms, have emerged as promising strategies to promote healthy eating habits among adolescents by using behavior change techniques (BCTs). This study aims to systematically review internet-based dietary interventions targeting adolescents, focusing on the analysis of BCTs employed, their delivery modes, and their impact on adolescents' adherence and engagement.

METHODS

PubMed, Scopus, and Web of Science databases were used up to July 2024. Eligible studies included randomized clinical trials involving adolescents aged 12 to 18. The interventions analyzed involved smartphone apps and web platforms promoting changes in eating habits, with results focusing on adherence and techniques used.

RESULTS

The initial search identified 5399 articles, of which 16 studies were included in the final analysis. The studies involved a total of 31,971 participants (range: 29-7890), with 40.29 % being female (n = 12,881), aged 12-18 years. The duration of interventions ranged from two weeks up to 12 months, with follow-ups of up to 24 months. Interventions that utilized BCTs such as goal setting (n = 14), feedback on behavior (n = 14), social support (n = 14), prompts/cues (n = 13), and self-monitoring (n = 12), were the most effective in promoting adherence and engagement. Digital dietary interventions that incorporated personalized feedback (n = 9) and gamification (n = 1) showed adherence rates between 63 % and 85.5 %, with notable improvements in dietary habits, such as increased fruit and vegetable consumption and reduced intake of sugar-sweetened beverages. However, the intervention using gamification involved only 36 participants, and its effects require further investigation due to the limited sample size.

CONCLUSION

Digital interventions show potential for promoting healthy dietary behaviors among adolescents, yet mixed outcomes underscore the challenges of maintaining adherence and long-term engagement. Techniques such as self-monitoring, goal setting, and social support can enhance engagement and effectiveness, particularly when combined with gamified features. The trial protocol is registered on PROSPERO (CRD42024564261).

Role of polygenic risk scores in the association between chronotype and health risk behaviors

BACKGROUND

This study explores the association between chronotypes and adolescent health risk behaviors (HRBs) by testing how genetic background moderates these associations and clarifies the influence of chronotypes and polygenic risk score (PRS) on adolescent HRBs.

METHODS

Using VOS-viewer software to select the corresponding data, this study used knowledge domain mapping to identify and develop the research direction with respect to adolescent risk factor type. Next, DNA samples from 264 students were collected for low-depth whole-genome sequencing. The sequencing detected HRB risk loci, 49 single nucleotide polymorphisms based to significant SNP. Subsequently, PRSs were assessed and divided into low, moderate, and high genetic risk according to the tertiles and chronotypes and interaction models were constructed to evaluate the association of interaction effect and clustering of adolescent HRBs. The chronotypes and the association between CLOCK-PRS and HRBs were examined to explore the association between chronotypes and mental health and circadian CLOCK-PRS and HRBs.

RESULTS

Four prominent areas were displayed by clustering information fields in network and density visualization modes in VOS-viewer. The total score of evening chronotypes correlated with high-level clustering of HRBs in adolescents, co-occurrence, and mental health, and the difference was statistically significant. After controlling covariates, the results remained consistent. Three-way interactions between chronotype, age, and mental health were observed, and the differences were statistically significant. CLOCK-PRS was constructed to identify genetic susceptibility to the clustering of HRBs. The interaction of evening chronotypes and high genetic risk CLOCK-PRS was positively correlated with high-level clustering of HRBs and HRB co-occurrence in adolescents, and the difference was statistically significant. The interaction between the sub-dimensions of evening chronotypes and the high genetic CLOCK-PRS risk correlated with the outcome of the clustering of HRBs and HRB co-occurrence.

CONCLUSIONS

The interaction of PRS and chronotype and the HRBs in adolescents appear to have an association, and the three-way interaction between the CLOCK-PRS, chronotype, and mental health plays important roles for HRBs in adolescents.

Utilizing the Electronic Medical Record to Enhance Health Care Provider Delivery of Messages About the Safe Storage of Firearms

The goal of this project was to determine whether screening youth and parents for firearm presence and imbedding those results in the electronic medical record (EMR) increased health care provider (HCP) documentation of firearms and subsequent delivery of a safe storage message. The study took place in a large adolescent medicine practice. Fifty-six dyads (40% of eligible) were randomized to usual care or the intervention, in which screening results for firearms were imbedded in the EMR. Health care providers delivered a safe storage message to 20% of controls and 51.2% in the intervention (P = .04). When HCPs documented the delivery of a safe storage message, 64% of parents recalled hearing it, compared with only 36% when there was no documentation (P = .012). Therefore, we found that incorporating firearm screening into the EMR increases the attention HCPs give to delivering a firearm safe storage message and correlates with parents recalling having heard a safe storage message.

Relationship between chronotype and mental behavioural health among adolescents: a cross-sectional study based on the social ecological system

BACKGROUND

Health risk behaviors (HRBs) is a kind of phenomenon behavior that often occurs in adolescence, and also often appears in clusters. Previous studies suggested an association between social ecological risk factors (SERFs) and HRBs. This study explored 1) whether chronotype moderates the risk of HRBs associated with SERFs and 2) whether mental health is a mediator in this relationship.

METHODS

Adolescents were recruited from 39 junior or senior schools (three cities, 13 schools per city) using a multistage cluster sampling method conducted between October, 2020 and June, 2021. The Social Ecological System, Morningness-Eveningness Questionnaire, Brief Instrument on Psychological Health Youths, and Youth Risk Behavior Surveillance questionnaires were used to measure the SERFs, chronotype, mental health and HRBs. Latent category analysis was used to explore the clustering mode of HRBs. The primary exposure was SERFs, and the primary outcome was HRBs; chronotype was a moderator, and mental health was a mediator. The multivariable logistic regression model was used to determine the relationship between SERFs and chronotype and mental behavioral health status. Mediation moderate analysis using the PROCESS method was used to explore the relationship between these variables. Sensitivity analysis was conducted to evaluate the robustness of the model.

RESULTS

In total, 17,800 individuals were initially enrolled. After excluding 947 individuals with invalid questionnaires, 16,853 participants were finally included in the analysis. The mean age of participants was 15.33 ± 1.08 years. After adjusting for covariates, multivariable logistic regression found that high levels of SERFs (odds ratio [OR] = 10.10, 95% confidence interval [CI]: 8.88-11.43, P < 0.01), intermediate chronotype (OR = 5.24, 95% CI: 4.57-6.01, P < 0.01), and eveningness (OR = 1.83, 95% CI: 1.64-2.05, P < 0.01) were associated with higher HRBs frequency. This study also assessed the interaction between chronotype, SERFs and HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01) and mental health (OR = 18.46, 95% CI: 13.16-25.88, P < 0.01). The moderated mediation analyses examined the relationship between chronotype, SERFs, mental health and HRBs.

CONCLUSIONS

SERFs may be important variables in measuring the effect of the adolescent psychosocial environment on HRBs; this effect is mediated by mental health and moderated by chronotype.

Sexual Health and Relationship Abuse Interventions in Pediatric Primary Care: A Systematic Review

PURPOSE

Supporting adolescents in developing healthy relationships and promoting sexual and reproductive health (SRH) is an important responsibility of pediatric primary care providers. Less is known about evidence-based interventions in pediatric settings focused on healthy relationships and SRH.

METHODS

We conducted a systematic review to describe SRH and healthy relationship/adolescent relationship abuse (ARA) interventions for pediatric primary care over the past 20 years. Eligible articles were original research on an SRH-focused or ARA-focused intervention, conducted in-person within pediatric primary care or school-based health centers specifically for middle or high school-aged adolescents. Data abstracted from included articles included intervention description, content, delivery, evaluation design, and effectiveness of primary outcomes. Heterogeneous outcomes and evidence levels made conducting a meta-analysis infeasible.

RESULTS

Nineteen studies described 17 interventions targeting a variety of SRH and ARA topics (e.g., sexually transmitted infections, contraception, ARA). Interventions largely focused on screening/counseling adolescents (89%). Interventions generally were reported as being effective in changing adolescent health or practice-level outcomes.

DISCUSSION

This review provides preliminary evidence that SRH and ARA interventions in pediatric primary care settings can be effective in promoting adolescent health. Future work should consider ARA-specific prevention interventions, including parents in interventions, and strategies for implementation, dissemination, and scaling.

Provider Use of Time Alone With Adolescents: Differences by Health Concern

PURPOSE

To examine associations between reports of sensitive health behaviors and the provision of time alone by a clinician during adolescent well visits.

METHODS

Data were collected from 547 adolescents who completed a well visit at one of eight clinics. Adjusted mixed logistic regression was used to examine whether reports of sexual behavior, substance use, disordered eating, mental health concerns, and demographic characteristics were associated with time alone.

RESULTS

Sexual behavior was found to be significantly associated with time alone, while substance use, disordered eating, a positive depression screen, and suicidal ideation were not. Older adolescents and males were more likely to report time alone, while race/ethnicity had no association with time alone.

DISCUSSION

Clinicians may be prioritizing time alone for behavioral concerns differently than for other sensitive behaviors.

Electronic Screening, Feedback, and Clinician Training in Adolescent Primary Care: A Stepped-Wedge Cluster Randomized Trial

PURPOSE

The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors.

METHODS

We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data.

RESULTS

Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald's T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen's d = .21), but not at 6 or 12 months.

CONCLUSIONS

The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.