ABSTRACT
The environment in which young people are growing up has changed significantly with the growth in social communication, changes in migration patterns and the proliferation of gangs. These changes pose a real and present danger to the health and well-being of young people in the UK and around the world. However, recognition of the safeguarding needs for this group continues to lag behind those of younger children and services often remain patchy and incomplete. We present a review of current safeguarding concerns as well as practical suggestions on their recognition and response for professionals working with young people in all branches of healthcare as well as education and wider society.
Subject(s)
Adolescent Health Services , Child Abuse, Sexual/prevention & control , Domestic Violence/prevention & control , Homeless Youth/statistics & numerical data , Juvenile Delinquency/prevention & control , Adolescent , Adolescent Behavior , Guidelines as Topic , Health Services Needs and Demand , Humans , Juvenile Delinquency/rehabilitation , Mandatory Reporting , Parent-Child Relations , Peer Group , Professional Role , Professional-Patient Relations , Social Support , United KingdomABSTRACT
PURPOSE: Opportunistic health screening has long been promoted by advocates of adolescent health. However, there are few objective data documenting the outcomes in an inpatient setting. METHODS: The authors performed opportunistic health screening on 114 surgical inpatients, median age 14 (range 10-18) years, admitted to a general adolescent ward in a tertiary children's hospital. A four-page paper document with a formatted list of questions, based on the Home, Education, Activities, Drugs, Sexual Health, Suicide framework, was developed to standardise screening and documentation. RESULTS: Areas of concern requiring intervention were identified in 34 (30%) patients. Specific interventions included referrals to the Adolescent Medicine clinic (n=6), Hospital School Services (n=7) and Psychological Medicine (n=7). CONCLUSIONS: Consideration should be given to offer adolescent health screening to all surgical inpatients. Further research should involve the participation of young people and should focus on the outcomes, feasibility, acceptability and resource implications of such screening.
Subject(s)
Adolescent Health Services/standards , Inpatients , Mass Screening/methods , Adolescent , Child , Elective Surgical Procedures/psychology , Hospitalization , Humans , Mass Screening/psychology , Mass Screening/standards , Practice Guidelines as Topic , Tertiary Care Centers , Western AustraliaABSTRACT
Rotavirus gastroenteritis is a major cause of morbidity and mortality among African infants and young children. A phase III, placebo-controlled, multi-centre clinical trial of a live, oral G1P[8] human rotavirus vaccine (RIX4414) undertaken in Malawi and South Africa significantly reduced the incidence of severe rotavirus gastroenteritis in the first year of life. We now report on vaccine efficacy in the Malawi cohort of children who were followed into the second year of life. A total of 1773 healthy infants were enrolled in Blantyre, Malawi into three groups. Two groups received three doses of RIX4414 or placebo at age 6, 10, and 14 weeks and the third group received placebo at 6 weeks and RIX4414 at age 10 and 14 weeks. Subjects were followed by weekly home visits for episodes of gastroenteritis until 1 year of age, and were then re-consented for further follow-up to 18-24 months of age. Severity of gastroenteritis episodes was graded according to the Vesikari scoring system. Seroconversion for anti-rotavirus IgA was determined on a subset of children by using ELISA on pre- and post-vaccine blood samples. Rotavirus VP7 (G) and VP4 (P) genotypes were determined by RT-PCR. A total of 70/1030 (6.8%, 95% CI 5.3-8.5) subjects in the pooled (2 dose plus 3 dose) RIX4414 group compared with 53/483 (11.0%, 8.3-14.1) subjects in the placebo group developed severe rotavirus gastroenteritis in the entire follow-up period (vaccine efficacy 38.1% (9.8-57.3)). The point estimate of efficacy in the second year of life (17.6%; -59.2 to 56.0) was lower than in the first year of life (49.4%; 19.2-68.3). There were non-significant trends towards a higher efficacy in the second year of life among children who received the three-dose schedule compared with the two-dose schedule, and a higher anti-rotavirus IgA seroresponse rate in the three-dose RIX4414 group. Rotavirus strains detected included genotype G12 (31%); G9 (23%); and G8 (18%); only 18% of strains belonged to the G1P[8] genotype. While the optimal dosing schedule of RIX4414 in African infants requires further investigation, vaccination with RIX4414 significantly reduced the incidence of severe gastroenteritis caused by diverse rotavirus strains in an impoverished African population with high rotavirus disease burden in the first two years of life.
