Adolescent Health Posters 107 – 112
107 Fetal Alcohol Spectrum Disorder: Identification And Diagnosis Of Adolescents And Young Adults With FASD In Primary Care
Fetal Alcohol Spectrum Disorder (FASD) often presents in childhood with learning and behavioural difficulties. Unique facial features may present in Fetal Alcohol Syndrome, the most severe form. If individuals are missed during childhood, identification and diagnosis becomes increasingly difficult due to the disappearance of the facial features, diverse presentations and overlap with other disorders, such as ADHD. Recent epidemiological work indicates that the prevalence of FASD in adolescents and adults is much higher than previously thought.
Diagnosis is essential as it allows access to support, which reduces the adverse outcomes associated with FASD. Consultations in general practice are often the only opportunity for identification of adolescents and adults with FASD. However, worldwide, there are no diagnostic criteria or current guidelines to aid clinicians in identifying FASD beyond childhood, making this extremely difficult and leaving a significant number of patients undiagnosed.
Our research examined the presentation of FASD in adolescents and adults, the difficulties of diagnosis in this age group and the international guidelines available. From this, we developed a prototype screening questionnaire to aid clinicians in general practice in identifying cases of FASD in adolescents and adults.
We use specific factors, more prevalent in FASD, such as their history (e.g. prenatal alcohol exposure, comorbid psychiatric disorders and conflict with the law) and their behavioural and cognitive difficulties, to statistically determine an individual’s likelihood of having FASD. We establish further directions for research including developing diagnostic criteria for this age group and the implementation of a screening programme in primary care.
108 Primary care interventions to improve the diagnosis and management of coeliac disease in adolescents
Coeliac Disease (CD) is a chronic illness affecting approximately 1% of the population. This permanent condition is characterised by symptoms of abdominal pain, diarrhoea, vomiting and constipation. These result from a self-attack produced by the body’s immune system, in response to ingestion of gluten proteins, contained in wheat, barley and rye. CD is classified by either the presence or absence of symptoms. A large proportion of those affected are either completely asymptomatic or have only very subtle bowel changes, making CD highly under-diagnosed.
Currently, the only treatment providing total symptomatic relief for patients is a gluten-free diet. However, for this mode of health management to be effective, patients require on-going monitoring and follow-ups in the primary care setting. Maintenance of this strict dietary regime is particularly poor amongst adolescent sufferers, who can be overwhelmed by the condition and its impact on their quality of life, coupled with the stigma often linked to bowel disorders.
Advancements in serological testing have shifted the diagnostic process of CD to the primary sector, giving GP’s chief responsibility in its fast and accurate diagnosis.We aim to focus on clinical aspects of CD, differentiating it from other similar conditions, making it more easily diagnosed in primary care. Also we highlight the importance of continued behavioural therapies and psychoeducation in young patients, many of whom have reduced coping capacity and certain personality traits that can lead to further complications of CD, including osteoporosis. Our methods for investigation include review articles of the recent literature surrounding CD.
109 “Soz I’m l8 Dr, did I keep u w8ing, if only you could txt, lol.” Are we communicating effectively with our technologically savvy teenagers?
Doctors have a mysterious vocabulary of medical terminology to communicate – terms such as tachycardia for fast heart rate to onychocryptosis for an ingrown toenail. However, with the pervasive nature of social media and the Internet there is now a new language emerging amongst young people -‘text speak.’
Many would argue the primary way teenagers communicate is now via email, texting and social media, with 92% going online daily.* This can be lambasted by traditionalists as the death of our language or embraced and utilised to engage with younger people. This is a golden opportunity to engage and improve their access to healthcare, below are some proposals to achieve this:
Texting – Patients are able to book an appointment online and many practices run adolescent clinics but the main aim would be for teenagers to book via text and be seen at their convenience after school. Results, normally sent by post, could be texted or an alert sent to say they need to contact the Practice and reminders for chronic disease management.
Social media – to embrace and use social media for positive ends it would be fantastic for a practice to have their own Facebook page. This could provide public health alerts, general housekeeping, encouragement for exercise and lifestyle, links to healthy eating recipes and news articles.It is vital that as GPs we embrace the technology available to our community and so readily used by young people daily. Further research and guidance on this subject will only serve to improve this relationship.
* Pew Research centre’s Teen Relationships survey 2014
110 Sexual health
In April 2014 the Sexual Health service at HM YOI Feltham which serves a population of approximately 550 young offenders aged 15-21 was reporting DNA rates of up to 40%, a waiting list of 80 patients and patients routinely waited 16 week s to be seen. The service’s primary objective is providing a discreet screening and treatment programme for A- symptomatic patients and sexual health promotion and advice for the wider population.
The objective of this exercise was to improve patient access, education, and an improved understanding healthcare systems and accessibility. One of the most critical changes to the service provision has been the significant reduction in the number of patients who for whatever reason fail to show up for a healthcare appointment. The impact on any healthcare service which runs with high levels of DNA’s is well documented IE clinical resources being wasted due to unscheduled down time, untreated illnesses leading to possible increase in the risk to health, Increased burden on administrative staff having to rebook appointments and an increase in the length of waiting times which are often combined with an increase in written complaints for longer waiting times.
We also want to identify the Blood Born Virus and sexual health related problems early on in order to treat and reduce morbidity. This whole process helped as reduced the DNA rates significantly and improve the education level of the clients. On the back of this we have now launched the dry blood spot testing and we hope to identify and treat Blood born Virsus related illness early on. We have also arranged for a follow up process upon release.
111 Training to Non Clinical Staff: ‘Making your Practice more Young Person Friendly’
Aims/Objectives: make local GP practices more young person (YP) friendly – improve knowledge and confidence of non clinical staff about YP health and health care needs-explore legal issues around YP health for non clinical staff-improve communication-tips/ideas on how practices can become more ‘YP friendly’
Content: The 2 hour training session included;- small group case discussion- young people’s rights; confidentiality, consent and competence.- introduction to the ‘adolescent brain’- brainstorming about how to make each GP practice more YP friendly- resource pack of information and posters
Relevance/Impact: Adolescence is a key stage to intervene in health behaviours and health choices which can have long lasting effects and yet currently YP don’t access and engage with primary care enough to benefit from the health promotion and support we offer. Non clinical staff are the key to creating a warm, open and accessible environment in surgeries. We conducted pre and post training questionnaires to measure improvements in confidence and knowledge in the course attendees.
Outcomes: – 39 members of staff representing 16 surgeries- Self rated scores post-training showed:o improvement in ‘confidence when dealing with adolescents in the surgery’o improvement in ‘knowledge of the differences between adolescents and adults’o improvement in ‘knowledge of the law concerning YP’
Discussion: The key to YP engagement in primary care is to show that we provide an open, trustworthy and confidential service. Educating and supporting staff to be “young people friendly” is crucial to improving access for YP. Further discussion to be had around other modalities of training eg online learning on this important topic.
112 Uptake of a new meningitis vaccine in first-year undergraduate students: the influence of demographic factors and the Health Belief Model
Aim: To determine the uptake of the vaccination against meningococcal groups A,C,W and Y (MenACWY) amongst first-year undergraduate students at the University of Liverpool and to elucidate how demographics and health beliefs impact vaccine uptake.
Content of presentation: An overview of the study. Relevance: In 2015 meningococcal group W (MenW) was declared endemic in the UK due to rising incidence and mortality, with adolescents disproportionately affected. The MenACWY vaccination was introduced amongst 14-18year olds and first-year university students to address this.
Outcome: The outcome variable was self-reported MenACWY vaccination. This was assessed via an electronic questionnaire encompassing demographic questions, the Health Belief Model and vaccination status. The analysis strategy encompassed hypothesis testing and univariate and multivariate logistic regression. 401 participants were included in analysis. Vaccine uptake was 68.1%. Variables that were independently associated with vaccination uptake in the multivariate model were age, university degree, perceived vaccine shortage and the perceived effectiveness of the vaccine at preventing meningitis. Age was negatively associated with vaccine uptake, with the odds of vaccination reducing with increasing age. Similarly, undertaking psychology degrees and increased perceptions of vaccine shortage reduced the odds of vaccination. In contrast, higher perceived vaccine effectiveness was associated with increased vaccine uptake.
Discussion: In future years, greater emphasis should be given to vaccinating older students who are less likely to have received vaccination in schools and where vaccination is currently opportunistic. This should include both policy attention and efforts by individual primary care and educational organisations. Targeted vaccine strategies that focus on specific student cohorts and that highlight both vaccine effectiveness and supply could also be considered.