Portal de Periódicos da CAPES

Adapting to adolescence

2016; Elsevier BV; Volume: 4; Issue: 6 Linguagem: Inglês

10.1016/s2213-2600(16)30111-4

2213-2619

The Lancet Respiratory Medicine,

Childhood Cancer Survivors' Quality of Life

Marcel Proust described adolescence as “an age which for all its alleged awkwardness, is prodigiously rich…the only time when we ever learned anything”. The period between childhood and adulthood offers a unique phase in which an individual's character matures and, in the case of those with a chronic disease, an opportunity to secure the optimum approach to disease management in adult life. The importance of effective health-care interventions for adolescents is neatly illustrated by the challenge of frequent non-adherence to treatment in this vulnerable population. For asthma, the most common chronic disease in childhood, the burden of disease is greatest in those aged 10–14 and 75–79 years—in the younger group, this is primarily caused by poor disease management. On April 28, 2016, the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) released the HEY YA! report, which was commissioned to identify reasons for non-adherence in adolescence. Between July and October, 2015, the EFA conducted interviews with 200 adolescent asthma patients—defined as 12–17 year olds—from France, Germany, Sweden, and the UK. Each participant was asked about six elements of their disease management: health status, asthma severity, attitudes, treatment, the role of doctors, and health literacy. The results showed that most adolescents accepted their doctors' advice, but of those requiring medication more than once a day, one in four did not adhere to their treatment plan. The main reasons for non-adherence were forgetfulness, rebellion, and underestimation of the significance of missing doses. The findings from the EFA report align with those from a Lancet Commission on adolescent health and wellbeing, published on May 9, 2016. The Commission, which uses the broadest definition of adolescence (10–24 year olds), states that over a third of adolescents live in areas with a high incidence of non-communicable diseases, where the major adolescent burden of disease is from mental and substance use disorders, and chronic physical illnesses such as asthma. The Commission authors discuss the developmental neuroscience and psychology behind how adolescents form opinions, and how their thought processes differ to adults. Adolescent reasoning is known to give greater weight to peer opinion and reputation, and young adults have heightened sensitivity to breaches of confidentiality and privacy. As the maturing adolescent's ability to participate in heath decisions develops, professionals must engage with them to build respectful relationships that empower the young person to develop the skills and knowledge to ultimately arrive at a point of autonomy over their disease management. In a chronic disease like asthma, it is imperative that adolescents have a tailored health plan, distinct to that experienced under their paediatric care. In patients with asthma, adherence falls sharply among 10–14 year olds, compared with 7–10 year olds, because reliance on parents to enforce good health behaviours no longer works in adolescence. Last year, WHO released global standards for quality health care services for adolescents. The EFA's proposed interventions to improve adherence in European adolescents accord with the recommendations from WHO. A mutually respectful patient–physician relationship, an appropriate package of services and information, patient involvement in decision making, and improved adolescents' health literacy are considered essential. Peer-led interventions such as peer-to-peer mentoring and peer education programmes have shown some success in improving adherence, and there is hope for the benefits of virtual relationships and interactive apps and games, such as those designed to remind patients when to take their drugs. “Adolescents are biologically, emotionally, and developmentally primed for engagement beyond their families. We must create the opportunities to meaningfully engage with them in all aspects of their lives”, concludes the Lancet Commission. This is certainly true for adolescents living with a chronic disease. Successful disease management requires professionals, patients, and parents to plan for the necessary transition of autonomy of care, at an age fitting for each individual. Clinicians must ensure they have the appropriate attitudes and skills to respond to an adolescent's health needs. During adolescence, individuals acquire the emotional, cognitive, and physical resources that will be the foundations of their adult life. It is essential that health-care providers are able to engage with adolescents at such a critical time of influence, to achieve optimum disease management and maximise each individual's prospects for a healthy future. Asthma online: pros and cons of social media and networksIn 2010, Gennaro D'Amato, professor of respiratory medicine (Medical School of Specialization University of Naples Federico II, Naples, Italy), reported a case of asthma exacerbations caused by psychological stress in an 18-year-old man on viewing his ex-girlfriend's Facebook profile. Full-Text PDF Gaming for asthma controlVideo games are one of the most popular pastimes among children in high-income countries and frequently fall under the scrutiny of the scientific establishment. Although many studies have been done to investigate the potential harms caused by their sedentary nature and so-called video-game addiction, others have focused on their potential educational benefits. As a medium that crosses gender, socio-economic, and cultural boundaries, video games are regarded by some medical experts as an ideal way to get children to take an interest in, and learn about, their own medical needs. Full-Text PDF