Elisabete Santos

Autoavaliação de médicos sobre sua formação em Medicina do Adolescente

AIMS: To characterize the way in which general and family physicians and pediatricians consider approaching adolescents, identify their qualifications in Adolescent Medicine, ascertain which topics of this specialty these physicians would like to see addressed in future training, and to compare the perceptions of physicians of both specialties with respect to their experience in adolescent health practice. METHODS: Cross-sectional study based on a survey sent by e-mail to 241 physicians in the area of influence of a level II hospital, including specific training interns or experts in Pediatrics and General and Family Medicine from health centers of the municipality of Viseu, Portugal. Chi-square tests or Fishers exact test were used to test associations between variables, assuming statistical significance when p <0.05. RESULTS: A total of 113 physicians completed the survey, of them 74% female, with a median of 12 years of practice (interquartile range 5-30, minimum 2 years, maximum 38 years). The pediatrics group had more training in Adolescent Medicine (57%) than the general and family medicine group (25%) (p=0.007). More physicians with specific training in Adolescent Medicine considered themselves prepared for the adolescent interview (51%, vs. 28% of those who did not have specific training, p=0.03). Family and general practitioners guided adolescents more about substance use, contraception, and sexually transmitted diseases, while pediatrics doctors identified more adolescents with depression. Most physicians rated themselves as having insufficient knowledge in Adolescent Medicine, with insufficient training being the most frequently referred barrier. Fifty-seven percent of pediatrics doctors, 78% of general practitioners and 84% of those with no specific training in Adolescent Medicine, considering the two specialties, would like to deepen their knowledge in this area. CONCLUSIONS: This study allowed identifying which areas of knowledge on Adolescent Medicine are deficient in the training of pediatricians and general practitioners. Most physicians, especially those with no training in Adolescent Medicine, showed interest in filling this gap.AIMS: To characterize the way in which general and family physicians and pediatricians consider approaching adolescents, identify their qualifications in Adolescent Medicine, ascertain which topics of this specialty these physicians would like to see addressed in future training, and to compare the perceptions of physicians of both specialties with respect to their experience in adolescent health practice.METHODS: Cross-sectional study based on a survey sent by e-mail to 241 physicians in the area of influence of a level II hospital, including specific training interns or experts in Pediatrics and General and Family Medicine from health centers of the municipality of Viseu, Portugal. Chi-square tests or Fishers exact test were used to test associations between variables, assuming statistical significance when p <0.05.RESULTS: A total of 113 physicians completed the survey, of them 74% female, with a median of 12 years of practice (interquartile range 5-30, minimum 2 years, maximum 38 years). The pediatrics group had more training in Adolescent Medicine (57%) than the general and family medicine group (25%) (p=0.007). More physicians with specific training in Adolescent Medicine considered themselves prepared for the adolescent interview (51%, vs. 28% of those who did not have specific training, p=0.03). Family and general practitioners guided adolescents more about substance use, contraception, and sexually transmitted diseases, while pediatrics doctors identified more adolescents with depression. Most physicians rated themselves as having insufficient knowledge in Adolescent Medicine, with insufficient training being the most frequently referred barrier. Fifty-seven percent of pediatrics doctors, 78% of general practitioners and 84% of those with no specific training in Adolescent Medicine, considering the two specialties, would like to deepen their knowledge in this area.CONCLUSIONS: This study allowed identifying which areas of knowledge on Adolescent Medicine are deficient in the training of pediatricians and general practitioners. Most physicians, especially those with no training in Adolescent Medicine, showed interest in filling this gap.

Improving the attitudes of primary care practitioners toward adolescent care: a pre-post intervention pilot study

Abstract Background Investing in adolescent health is among the most cost-effective health measures. Primary care practitioners are ideally positioned to deliver such interventions. However, several barriers hinder them from engaging with adolescents. Objective To pilot test the impact of a 1-day training session on adolescent health on the attitudes of primary care practitioners toward adolescent care. Subjects Participants were family physicians and nurses enrolled in a 1-day training session on adolescent health. Methods A non-randomized, pre-post intervention study with no control group. Data on barriers for providing care to adolescents, preferred pediatric age group and attitudes toward adolescent care were collected immediately prior. Participants’ attitudes were measured again immediately after training. Results Most participants reported they preferred to attend pediatric groups other than adolescents. The most frequently reported barriers were: excessive amount of time needed and lack of training. Participants reported positive pre-training attitudes, with mean scores above the midpoint of the scale in all dimensions. Significant positive improvements were observed after training in Adequacy, Self-esteem and Satisfaction. Subgroup analysis showed that at baseline, professionals who preferred to work with adolescents had significantly more positive attitudes in Adequacy, Self-esteem and Satisfaction. After training there was a general improvement in attitudes in both groups, with attenuation of the differences between them. Conclusion Participation in a 1-day tailored educational intervention on adolescent health had a positive impact on the attitudes of primary care practitioners, regardless of their preferred age group. This improvement may lead to more active engagement with adolescents and substantial health gains.

Cryptorchidism in adolescence.

INTRODUCTION An early investigation and management op cryptorchidism are essential for the diagnosis of associated pathologies, because intra-abdominal testis are associated with infertility and neoplasic risk. The authors describe a case of late presentation of cryptorchidism associated with genetic disorder. CASE REPORT Adolescent male with 17 years old, referred to Adolescent Clinic for short stature and bilateral cryptorchidism. Hypertension, short stature and bilateral cryptorchidism were detected in clinical evaluation. Bone age is coincident with chronological age and testosterone was slightly below normal values. The study of secondary hypertension was negative. He underwent bilateral orchidopexy, and histological analysis revealed severe bilateral testicular atrophy. The karyotype showed 45,X[15]/46,X,+mar.ish der(Y)(SRY+)[117] mosaicism. COMMENTS With this case report the authors intend to enhance the need of early management of cryptorchidism and short stature, in order to improve the prognosis.