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Fox H.B.,Advance Health | McManus M.A.,Advance Health | Irwin Jr. C.E.,University of California at San Francisco | Kelleher K.J.,Research Institute at Nationwide Childrens Hospital | Peake K.,Mount Sinai Adolescent Health Center
Journal of Adolescent Health | Year: 2013

Little attention has been given to how primary care can be transformed to better meet the needs of adolescents. To help generate the evidence needed, The National Alliance to Advance Adolescent Health convened an invitational conference in 2012 in Washington, DC. Participants from various disciplines identified a set of prioritized recommendations pertaining to 3 topics: increasing adolescent and parent engagement and self-care management; improving preventive care and identifying conditions early; and integrating physical, behavioral, and reproductive health services. This commentary includes the top three recommendations for each topic area and concludes with a brief examination of federal and private funding prospects. © 2013 Society for Adolescent Health and Medicine. All rights reserved. Source

Steever J.,Mount Sinai Adolescent Health Center
Pediatric Annals | Year: 2014

Many transgender youth experience significant amounts of emotional distress regarding the incongruence between their internal gender identity and their physical body. Crossgender hormonal medical treatments, as managed by a multidisciplinary medical/mental health team, assist patients in transitioning to their desired gender by aligning the physical body to match the gender identity. The World Professional Association for Transgender Health Standards of Care and the Endocrine Society's Clinical Practice Guidelines provide a basic road map for practitioners. Expectations of the youth and the concerns of the family must be addressed and the youth psychologically supported during the transition period. Issues around future fertility should be explored as well. The goal of this article is to introduce the general pediatrician to cross-gender hormone treatments, their management, monitoring laboratory tests and clinical effects, and the issues surrounding their use in adolescents. © SLACK Incorporated. Source

Gee R.E.,Louisiana State University | Brindis C.D.,Bixby Center for Global Reproductive Health | Brindis C.D.,University of California at San Francisco | Diaz A.,Mount Sinai Adolescent Health Center | And 5 more authors.
Current Opinion in Obstetrics and Gynecology | Year: 2011

Purpose of review: In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. Recent findings: The women's health amendment to the ACA (Federal Register, 2010) requires that new private health plans cover - with no cost-sharing requirements - preventive healthcare services for women. Congress requested that a review be conducted to ascertain whether there were any additional needed preventive services specific to women's health that should be included. Summary: The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Francis J.,Mount Sinai Adolescent Health Center | Malbon K.,Tribeca Pediatrics | Braun-Courville D.,Mount Sinai Adolescent Health Center | Lourdes L.O.,Mount Sinai Adolescent Health Center | Santelli J.,Columbia University
Journal of Adolescent Health | Year: 2014

Purpose: To examine the association between symptoms of depression and ambivalence about pregnancy in an inner-city adolescent female population. Methods: This study analyzed data from 220 urban minority adolescent females (ages, 15-19 years) presenting for contraceptive initiation in a comprehensive, free-of-cost, adolescent health center in New York City. Cross-sectional baseline data were examined to define the relationship between participants' ambivalence toward pregnancy (defined by responses to items previously used in the National Longitudinal Study of Adolescent Health) and symptoms of depression (assessed by the Center for Epidemiological Studies-Depression scale). After controlling for covariates, multivariate logistic regression was used to identify the unique contribution of symptoms of depression on the pregnancy ambivalent group. Results: Over one third of adolescent females self-reported ambivalence about pregnancy (n = 73, 33%). In our sample, 20% (n = 45) reported mild and 14% (n = 30) reported moderate-to-severe symptoms of depression. After controlling for potentially confounding factors, adolescent females who reported mild symptoms of depression had increased odds of reporting pregnancy ambivalence (adjusted odds ratio, 3.53; confidence interval, 1.64-7.62; p = .001) compared with those with minimal symptoms of depression. Conclusions: A substantial number of adolescents, despite planning to initiate contraception, were ambivalent about pregnancy; those reporting ambivalence were more likely to report mild symptoms of depression. When counseling adolescents about contraception initiation, clinicians should be aware that mild symptoms of depression may contribute to ambivalence about pregnancy. © 2014 Society for Adolescent Health and Medicine. Source

Nooner K.B.,Montclair State University | Nooner K.B.,The Nathan S Kline Institute For Psychiatric Research | Linares L.O.,Mount Sinai Adolescent Health Center | Batinjane J.,Montclair State University | And 2 more authors.
Trauma, Violence, and Abuse | Year: 2012

Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3-57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents' strengths and minimize vulnerabilities. Public policy implications are discussed. © The Author(s) 2012. Source

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