Adolescent confidentiality: Understanding and practices of health care providers.

BACKGROUND: Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada. OBJECTIVE: To investigate the knowledge and practice of health care providers at Alberta Children's Hospital (Calgary, Alberta), and to inform practice about the adolescent's right to confidentiality. METHODS: The present study was a voluntary, anonymous online survey. Invitations to participate were sent through the paediatric facility's electronic mailing list to all currently employed health care providers who potentially engaged in caregiving interactions with adolescents. The survey consisted of 15 closed items and seven open comment items. Closed items were analyzed using descriptive statistics and open comments were analyzed using manifest thematic coding. RESULTS: A total of 389 responses were received, representing health care providers in many disciplines. A variety of practices related to adolescent confidentiality and widespread misunderstanding of this issue were apparent. Respondents' comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents. CONCLUSIONS: While health care providers regard confidentiality as paramount, the present survey revealed a wide variation in understanding and practices regarding confidential care for adolescents. This was revealed in both the qualitative and quantitative data. The authors' recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals' examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy.

HISTORIQUE: Le respect de la confidentialité des adolescents peut présenter des problèmes dans le cadre de la pratique des dispensateurs de soins auprès de la famille et des processus médicaux, éthiques, juridiques, sociaux et bureaucratiques. On ne sait pas comment les dispensateurs de soins comprennent et exercent la confidentialité auprès des adolescents au Canada. OBJECTIF: Examiner les connaissances et les pratiques des dispensateurs de soins de l'Alberta Children's Hospital de Calgary, en Alberta, et étayer les pratiques au sujet du droit des adolescents à la confidentialité. MÉTHODOLOGIE: La présente étude a pris la forme d'un sondage virtuel anonyme et volontaire. Les invitations à participer ont été expédiées par la liste de courriels de l'établissement pédiatrique à tous les dispensateurs de soins détenant un poste et susceptibles de participer aux soins d'adolescents. Le sondage se composait de 15 questions fermées et de sept questions ouvertes. Les chercheurs ont analysé les questions fermées au moyen de statistiques descriptives, et les questions ouvertes au moyen d'un code thématique manifeste. RÉSULTATS: Les chercheurs ont reçu un total de 389 réponses, représentant des dispensateurs de soins de diverses disciplines. Ils ont constaté diverses pratiques liées au respect de la confidentialité des adolescents et une incompréhension généralisée de la question. Les commentaires des répondants ont révélé des lacunes de la part des individus et des équipes au sujet des droits des adolescents et des parents ou des tuteurs, et une différence entre les concepts de consentement au traitement et la prestation de soins confidentiels aux adolescents. CONCLUSIONS: Les dispensateurs de soins considèrent la confidentialité comme fondamentale, mais le sondage a révélé une vaste variation de la compréhension et des pratiques quant à la confidentialité des soins des adolescents, tant dans les données qualitatives que quantitatives. Les auteurs recommandent des stratégies pour améliorer la compréhension et les pratiques en matière de respect de la confidentialité chez les adolescents, soit encourager les individus à examiner leurs croyances et favoriser les études postsecondaires, les stratégies de transfert du savoir au sein des programmes et les directives et politiques établies par l'établissement.

Care of adolescent parents and their children.

Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Gambling in children and adolescents.

Despite the fact that minors in Canada are prohibited from legalized gambling, adolescents commonly engage in both legalized (lottery products, casino, video lottery terminals) and self-organized (cards, sports betting, dice) gambling activities both at home and in school. Lifetime prevalence rates of pathological gambling for adults range from 1% to 2%, and existing data suggest that the prevalence among adolescents may be two to four times higher. Very little is known about risk factors in the development and perpetuation of problematic and pathological gambling. This statement is intended to educate paediatricians, family physicians and other health care providers about the emerging knowledge around gambling in childhood and adolescence and the potential serious consequences of this activity. It also urges federal, provincial and territorial governments to include this specific issue in their agendas and to address the socio-political factors associated with gambling.

Say goodbye and say hello: the transition from pediatric to adult gastroenterology.

Pediatric and adult gastroenterologists have identified an important issue to be addressed which entails the process of transition of care for youth affected by chronic gastrointestinal disorders. The adolescent years are a time of change and development, and may be significantly affected by conditions such as Crohn's disease or ulcerative colitis. Health care providers need to advocate and provide comprehensive, developmentally appropriate care for youth and families to facilitate the transition from the pediatric to the adult setting. The present article will review important aspects of the transition from the pediatric to the adult care health system.

Cineangiographic aortic dimensions in normal children.

Knowledge of normal aortic dimensions is important in the management of children with aortic disease. So as to define such dimensions, we undertook a retrospective review of clinical data and aortic cineangiograms from 167 subjects without aortic disease having a mean age of 3.67 years, with a range from 0.01 to 14.95 years. Amongst the patients, 56 were without detectable cardiac lesions, 66 patients had mild pulmonary stenosis, 30 were seen with Kawasaki disease, and 15 with small interatrial defects within the oval fossa. Aortograms were available in all. No patient had any hemodynamic derangement that would have affected the aorta during intrauterine life or childhood. Systolic dimensions were measured in the ascending and descending aorta at the level of the carina, at the transverse aortic arch distal to the brachiocephalic, of the left common carotid artery at its origin, at the transverse aortic arch distal to the left common carotid artery, at the aortic isthmus, and of the aorta at the level of the diaphragm. A regression analysis model was used to establish the range of predicted normal values, with their confidence limits, standardizing the values to height as the biophysical parameter having the highest correlation to aortic dimensions. Normal ranges were established for all the levels of measurement. The data should prove useful in identifying abnormalities of the thoracic aorta during childhood, and when assessing the outcomes of interventions.