Aspectos históricos da institucionalização da atenção à saúde do adolescente no estado de São Paulo, 1970-1990 / Historical aspects of the institutionalization of adolescent healthcare in the state of São Paulo, 1970-1990

Trata de aspectos históricos da atenção integral à saúde dos adolescentes no estado de São Paulo, sobretudo quanto à implantação de serviços e programas pioneiros. Contextualiza desafios, embates e dificuldades gerados no âmbito das instituições implicadas no desenvolvimento desse campo, à luz das perspectivas da medicina clínica e da saúde coletiva, tendo como pano de fundo o contexto sociopolítico brasileiro na época. Fundamentado em material documental, recupera-se a construção de núcleos de expertise e do campo da saúde do adolescente na dialética entre a construção de uma nova área de atuação médica com base na clínica e um campo de saberes e práticas da saúde coletiva com base na integralidade da atenção à saúde, de caráter interdisciplinar e intersetorial.

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.

Aspectos históricos da institucionalização da atenção à saúde do adolescente no estado de São Paulo, 1970-1990 / Historical aspects of the institutionalization of adolescent healthcare in the state of São Paulo, 1970-1990

Trata de aspectos históricos da atenção integral à saúde dos adolescentes no estado de São Paulo, sobretudo quanto à implantação de serviços e programas pioneiros. Contextualiza desafios, embates e dificuldades gerados no âmbito das instituições implicadas no desenvolvimento desse campo, à luz das perspectivas da medicina clínica e da saúde coletiva, tendo como pano de fundo o contexto socio político brasileiro na época. Fundamentado em material documental, recupera-se a construção de núcleos de expertise e do campo da saúde do adolescente na dialética entre a construção de uma nova área de atuação médica com base na clínica e um campo de saberes e práticas da saúde coletiva com base na integralidade da atenção à saúde, de caráter interdisciplinar e intersetorial. (AU)

[A historical perspective on the health of boys and male adolescents (1780-2010)]. / Die Gesundheit von Jungen und männlichen Jugendlichen in historischer Perspektive (1780-2010).

In the discourse on health, boys are emerging as a problem group. In contrast to girls who tended to be seen as fragile if not sickly, boys used to be thought of as strong and healthy. Gender-specific concepts stipulated much more exercise for boys, the masturbation discourse prevented a relaxed relationship to the own body. The paper first describes specific problems in the biography (babies, child labour, tuberculosis, school, fitness for military service) and their solutions up to the time of the Weimar Republic. During and after the two world wars school boys tended to be of poorer health than girls. The consequences of war affect the mental health of (half-) orphans gender-non-specifically up to the third generation. After 1945, attention to health concerns is rather restricted to the professional aptitude of mining trainees, health-related risk behaviour tends to be interpreted in terms of gender. Mothers sought medical advice slightly more frequently on behalf of boys up to puberty. Concerning the time between 1780 and 2010 inferior health is often noticeable in boys and male adolescents. This used to, and still does, apply to babies, child labour, industrial work and occupational accidents, conscription and direct consequences of war. It was mostly due to gender-specific separation of labour, but partly also to a higher risk preference. The gender-specific wider scope for exercise and sports up to the 1960s, in contrast, had a health-promoting effect.

Adolescent medicine with a 100 year perspective.

Adolescent medicine was born out of scientific advances from a wide variety of disciplines, changes in societal mores and the explosion of technology that occurred during the 20th century. The past 100 years of clinical practice and research have provided a wealth of information that has improved our understanding of the biologic and physical development of adolescents as well as the epidemiology of high-risk adolescent behaviors. The present challenge for all providers of health care to adolescents is to continue to examine the effect of these high-risk behaviors and develop mechanisms to address and limit the impact of these behaviors, just as the scientists and practitioners of the 20th century made great strides in treatment and cure of medical illnesses. With a broad base of scientific knowledge, formalization into an academic field and strong government and organizational support adolescent medicine are energized by these factors and can only envision continued growth in this important field of medicine.

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.