Adolescent health in the sustainable development goal era: Are we aligned for multisectoral action?

Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multisectoral action for adolescent health, to understand the context of such change and to spark, sustain and steer it

Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

Purpose: This study aimed to examine family (patient, parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit. Methods: Four focus groups with teen patients (n = 16), four focus groups with parents (n = 15) and one focus group with providers (n = 12) were conducted using a structured moderator guide tailored to each population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia or elevated blood pressure. Parents who attended their child’s well-child visit and whose child met the diagnostic criteria were eligible. Teen focus groups were divided by gender (male/female) and age (14–15/16–17 years). Focus group transcripts were coded for concepts and themes using qualitative data and thematic analysis. Analysis was performed across groups to determine common themes and domains of intersect. Results: Teens and parents expect weight to be discussed at well-child visits and prefer discussions to come from a trusted clinician who uses serious, consistent language. Teens did not recognize the health implications from excess weight, and both parents and teens express the need for more information on strategies to change behavior. Providers recognize several challenges and barriers to discussing weight management in the well-child visit. Conclusions: A clinician-teen-family relationship built on trust, longevity, teamwork, support and encouragement can create a positive atmosphere and may improve understanding for weight-related messages for teens and families during a well-child visit

Count every newborn; a measurement improvement roadmap for coverage data.

BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks

Countdown to 2030 : tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Overweight adolescents and asthma: Revealing motivations and challenges with adolescent-provider communication

OBJECTIVE: Among teens with asthma, challenges of disease management may be greater in those with a body mass index (BMI) \u3e85th percentile compared to youth within the parameters for normal weight-for-age. This mixed-methods study assessed teens\u27 awareness of the link between weight and asthma management, and perspectives on how medical providers might open a discussion about managing weight. METHOD: Teens aged 13-18, having BMI \u3e85 percentile and chronic asthma, identified using health system databases and a staff email message board, were invited to complete a semi-structured, in-depth phone interview. Interviews were audio taped, transcribed, and qualitatively analyzed, using the Framework Method. Responses were summarized and themes identified. Descriptive summaries were generated for a 16-item survey of weight conversation starters. RESULTS: Of 35 teens interviewed, 24 (69%) were girls, 11 (31%) boys, 20 (63%) African-American. All teens reported having the weight conversation with their doctors, and preferred that parents be present. Half knew from their doctor about the link between being overweight and asthma, others knew from personal experience. Nearly all expressed the importance of providers initiating a weight management conversation. Most preferred conversation starters that recognized challenges and included parents\u27 participation in weight management; least liked referred to carrying around too much weight. CONCLUSIONS: Most teens responded favorably to initiating weight loss if it impacted asthma management, valued their provider addressing weight and family participation in weight management efforts. Adolescents\u27 views enhance program development fostering more effective communication targeting weight improvement within the overall asthma management plan

Weight-Related Messages in Well-Child Visits: What Do Teens Desire?

Background/Aims: With the United States’ prevalence of childhood obesity at approximately 17%, well-child visits are a critical time to discuss well-being, physical activity and other concerns. Discussion of healthy weight is a key component of these pediatric visits. Appropriate delivery of weight-related messages to adolescents and their families is critical. Accusatory messages may distance adolescents from health care, whereas nondirect approaches could suggest unhealthy weight is nonproblematic. Feedback on weight-related messages during the well-child visit may improve health care delivery in this setting. Methods: Opinions on weight, weight-related messaging, blood pressure and lipid testing knowledge were collected through focus groups with adolescents 14–18 years old. Eligible adolescents had a body mass index \u3e 85th percentile and/or a diagnosis of high blood pressure or high cholesterol. A framework matrix method was used for data analysis. Results: Four focus groups, stratified by gender, were held (16 participants [9 male]; mean age 15.7 ± 1.05 years). Teens expressed that a relationship based on provider trust, built over time, with personal and parental responsibility, are important aspects of the well-child “team.” Adolescents voiced strong desire for parental inclusion in health-related discussions. Ideal parental involvement was described as supportive and encouraging to provider recommendations. Teens expressed a lack of knowledge and awareness, along with misconceptions, about health consequences due to unhealthy weight, blood pressure and cholesterol. Providers were described as a resource to discuss weight-related topics; teens expected and welcomed weight-related conversations. Adolescents appreciated casual conversations based on activities and interests, although a serious approach was considered helpful to encourage meaningful changes. Discussions about blood pressure, cholesterol and diabetes were categorized as “scary” and “overwhelming.” Conclusion: Our data suggest a provider-adolescent relationship built on trust, team work, support and encouragement creates a positive atmosphere for weight-related messages for teens during a well-child visit. Adolescents described long-standing patient-provider histories, suggesting a pediatric medical home concept may be critical in positive discussions of weight. Next steps include analyzing similar parent and provider focus group data and incorporating focus group concepts into a patient-centered, brief, educational intervention for providers focusing on weight-related messages during the well-child visit

Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

Purpose: To examine family (patient and parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit. Methods: Four focus groups with teen patients (n=16), four focus groups with parents (n=15), and one focus group with providers (n=12) were conducted using a structured moderator guide tailored to each specific population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia, or elevated blood pressure. Parents who attended their child\u27s well-child visit and had a child meeting these same criteria were eligible. Teen focus groups were divided by gender (male/female) and age (14-15y/16-17y). Focus group transcripts were coded for concepts and themes using qualitative data and thematic analysis. Analysis was performed across groups to determine common themes and domains of intersect. Results: Teens and parents expect weight to be discussed at well-child visits, and prefer discussions to come from a trusted clinician who uses serious, consistent language. Teens did not recognize the health implications from excess weight, and both parents and teens express the need for more information on strategies to change behavior. Providers recognize several challenges and barriers to discussing weight management in the well-child visit. Conclusion: A clinician-teen-family relationship built on trust, longevity, teamwork, support, and encouragement can create a positive atmosphere and may improve understanding for weight-related messages for teens and families during a well-child visit

Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

Purpose: This study aimed to examine family (patient, parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit. Methods: Four focus groups with teen patients (n = 16), four focus groups with parents (n = 15) and one focus group with providers (n = 12) were conducted using a structured moderator guide tailored to each population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia or elevated blood pressure. Parents who attended their child’s well-child visit and whose child met the diagnostic criteria were eligible. Teen focus groups were divided by gender (male/female) and age (14–15/16–17 years). Focus group transcripts were coded for concepts and themes using qualitative data and thematic analysis. Analysis was performed across groups to determine common themes and domains of intersect. Results: Teens and parents expect weight to be discussed at well-child visits and prefer discussions to come from a trusted clinician who uses serious, consistent language. Teens did not recognize the health implications from excess weight, and both parents and teens express the need for more information on strategies to change behavior. Providers recognize several challenges and barriers to discussing weight management in the well-child visit. Conclusion: A clinician-teen-family relationship built on trust, longevity, teamwork, support and encouragement can create a positive atmosphere and may improve understanding for weight-related messages for teens and families during a well-child visit