Primary care
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Review
Human Trafficking in Adolescents: Adopting a Youth-centered Approach to Identification and Services.
This article describes core design features of a youth-centered approach to care that 2 organizations-Mount Sinai Adolescent Health Center and Covenant House New Jersey-use to serve clients in nontraditional primary care settings and subsequently illustrates the ways in which this approach succeeds at identifying and serving youth who have experienced human trafficking. Primary care providers are uniquely positioned to connect adolescent human trafficking survivors to existing protection and treatment resources. The primary care community can adapt these interventions for adolescent patients who have experienced human trafficking and become key personnel on the frontline of recovery and prevention.
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This article describes the current scope of immigration to the United States, defines the different categories of immigrants, and describes the Centers for Disease Control and Prevention-mandated overseas and postarrival medical assessment of adolescent refugees. Guidelines for primary care physicians who care for refugee youth are provided, including diagnosis and treatment of common medical and mental health conditions. Special considerations in caring for this vulnerable population include acknowledging prior traumas, acculturation and challenges to education such as bullying, and adjustment to a new health care system that emphasizes preventive care in addition to curative medical care.
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Adolescents often experience trauma that can affect their daily function and lead to health-related issues and outcomes. However, medical providers receive limited training on the impact of trauma on adolescents and how to incorporate that information into treatment practices. ⋯ An overview of current assessments and evidence-based interventions to address adolescent patients' crisis needs is provided. In addition, recommendations for community referrals and partnerships that could improve the health outcomes of these youth are discussed.
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Musculoskeletal care of the adolescent patient involves unique knowledge of their rapidly changing physical and psychological health. In this article, the importance of preventing early sports specialization is elucidated, and an encouragement of the safety and necessity of resistance training in adolescents is undertaken. It also explores two common conditions, one affecting the immature skeleton (apophysitis), and one affecting the improperly developed muscular system (patellofemoral syndrome), both of which are diagnosed clinically, and require little advanced imaging. Finally, a brief overview of relative energy deficiency in sport is given.
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Evaluation of the child with abnormal pubertal development can be challenging for the primary care provider. Understanding the factors associated with timing of pubertal onset and the normal sequence of pubertal changes is useful in evaluation of children with puberty disorders. A thorough workup includes assessment of growth rate, Tanner staging, and rate of pubertal progression, in addition to an extensive history and physical examination to identify signs and symptoms of disorders associated with abnormal pubertal timing. Initial diagnostic studies will most often include a bone age, levels of gonadotropins, and levels of estradiol (for girls) or testosterone (for boys).