Identifying challenges in promoting adolescent preventive health care in the primary care setting of urban Japan
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Kazumi Sakashita
and
Robert W. Blum
Abstract
Background
Despite the assurance of free medical access through the universal health insurance system, over the past three decades Japanese youth have experienced an increase in developmental and behavioral problems, psychosomatic disorders, and psychiatric illnesses.
Objectives
To identify the challenges in promoting comprehensive preventive health services to adolescents in Japan, specifically in Tokyo.
Methods
A cross-sectional online survey was conducted of physicians who are members of the Tokyo Pediatric Association. The questionnaire assessed primary care pediatricians’ practice settings and their attitudes toward outpatient services to adolescent patients.
Results
Out of 617 member pediatricians, 69 valid responses were obtained. Majority were private pediatricians. 52% indicated that they had specialties in addition to general pediatrics; however, no one reported specializing in adolescent medicine. Approximately 70% answered the optimal patient encounter time would be under 10 min. More than 90% of respondents reported challenges providing health services to adolescent patients. Nearly half indicated that they did not routinely evaluate height, heart rate or blood pressure. Few providers asked about reproductive health, violence, or smoking/alcohol use.
Conclusion
This survey is the first exploration of adolescent health care in an urban area of Japan. While the sample is small, the magnitude of challenges was great with limited training in adolescent medicine, severe time constraints and limited appreciation for the value of health screening at each encounter. Developing a standardized practical assessment tool for adolescent patients may help guide primary care pediatricians to better meet the needs of their adolescent patients.
Acknowledgments
The authors especially acknowledge Chieko Akiyama, BM, PhD, of Akiyama Children Clinic (Tokyo, Japan), Executive board member of Tokyo Pediatric Association, and Yoshiki Hanawa, BM, of Hanawa Pediatric Clinic (Tokyo, Japan), President of Tokyo Pediatric Association for their thorough support conducting this survey. The authors thank members of Tokyo Pediatric Association who joined this online survey.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
References
1. Ministry of Health, Labour and Welfare. History of our health care system: annual health, labour and welfare report; 2007:4–20 pp. Available at: https://www.mhlw.go.jp/wp/hakusyo/kousei/07/dl/0101.pdf [Accessed 20 May 2020]. [In Japanese].Search in Google Scholar
2. Ministry of Education, Culture, Sports, Science and Technology. Ordinance for enforcement of School Health and Safety Act. Ministry of internal affairs and communications. Available at: https://elaws.e-gov.go.jp/search/elawsSearch/elaws_search/lsg0500/detail?lawId=333M50000080018#C [Accessed May 20, 2020]. [In Japanese].Search in Google Scholar
3. Primary and Secondary Education Bureau. Survey reports about challenges of student guidance including behavioral problems, school absenteeism, and others, the academic year of 2018. Ministry of Education, Culture, Sports, Science and Technology, 2019. Available at: https://www.mext.go.jp/content/1410392.pdf [Accessed May 20, 2020]. [In Japanese].Search in Google Scholar
4. Murakami, K. Introduction. In: The Japanese Society of Psychosomatic Pediatrics, The Clinical guidelines on psychosomatic diseases in childhood., 2nd ed. Tokyo: Nankodo; 2015. vii. [In Japanese].Search in Google Scholar
5. Igarashi, T. Research report about biopsychosocial health of children. Research Grant Project to Support Child and Child Rearing 2017 (Kodomo Kosodate Shien Suishin Chosa Kenkyu Jigyo); Ministry of Health, Labour and Welfare; 2018. Available at: https://www.mhlw.go.jp/content/11900000/000520474.pdf [Accessed May 20, 2020. [In Japanese].Search in Google Scholar
6. Office of Demographics, Health and Social Statistics. Annual report of vital statistics 2018. Ministry of Health, Labour and Welfare. Available at: https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai18/dl/gaikyou30.pdf [Accessed May 20, 2020. [In Japanese].Search in Google Scholar
7. Social and Support Bureau, Ministry of Health, Labour and Welfare. Life safety bureau, national police agency. Suicide Report 2018. Ministry of Health, Labour and Welfare; 2019. Available at https://www.mhlw.go.jp/content/H30kakutei-01.pdf [Accessed 20 May 2020. [In Japanese].Search in Google Scholar
8. Insurance Bureau. Basic data about health care insurance: status report of medical expenditure 2017. Ministry of Health, Labour and Welfare; 2019. Available at: https://www.mhlw.go.jp/content/kiso_h29.pdf [Accessed 20 May 2020. [In Japanese].Search in Google Scholar
9. American Academy of Pediatrics. Adolescence visits. In: Hagan, JF, Shaw, JS, Duncan, PM, editors Bright futures: guidelines for health supervision of infants, children, and adolescents, 4th ed. American Academy of Pediatrics; 2017. pp. 631–822.Search in Google Scholar
10. Montalto, NJ. Implementing the guidelines for adolescent preventive services. Am Fam Phys 1998;57:2181–8.Search in Google Scholar
11. Stephens, MB. Preventive health counseling for adolescents. Am Fam Phys 2006;74:1151–6.Search in Google Scholar
12. Cohen, E, Mackenzie, RG, Yates, GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. J Adolesc Health 1991;12:539–44. https://doi.org/10.1016/0197-0070(91)90084-y.Search in Google Scholar PubMed
13. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System (YRBSS). U.S. Department of Health & Human Services; 2018. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/index.htm [Accessed 20 May 2020].Search in Google Scholar
14. The Japan Society of Adolescentology. Outline of society; 2019. Available at: http://www.adolescence.gr.jp/outline/index.html [Accessed 20 May 2020].Search in Google Scholar
15. Japanese Society for Adolescent Psychiatry. Outline of society; 2019. Available at: http://jsaphp.com/ [Accessed 20 May 2020].Search in Google Scholar
16. Golub, SA, Arunakul, J, Hassan, A. A global perspective: training opportunities in Adolescent Medicine for healthcare professionals. Curr Opin Pediatr 2016;28:447–53. https://doi.org/10.1097/MOP.0000000000000366.Search in Google Scholar PubMed
17. Ministry of Health, Labour and Welfare. Revision of medical fee; 2020. Available at: https://www.mhlw.go.jp/content/12400000/000603747.pdf [Accessed 20 May 2020]. [In Japanese].Search in Google Scholar
18. Ministry of Health, Labour and Welfare. National health and nutrition survey. Ministry of Health, Labour and Welfare 2017;111. Available at: https://www.mhlw.go.jp/content/000451755.pdf [Accessed 20 May 2020]. [In Japanese].Search in Google Scholar
19. Office of Comprehensive Education Policy. School health statistics 2018. Ministry of Education, Culture, Sports, Science and Technology 2018. Available at: https://www.mext.go.jp/component/b_menu/other/__icsFiles/afieldfile/2019/03/25/1411703_01.pdf [Accessed 20 May 2020]. [In Japanese].Search in Google Scholar
20. Anderson, KL. A review of the prevention and medical management of childhood obesity. Child Adolesc Psychiatr Clin N Am 2018;27:63–76. https://doi.org/10.1016/j.chc.2017.08.003.Search in Google Scholar PubMed
21. West, EH, Hark, L, Catalano, PM. Nutrition during pregnancy. In: Steven, G, Gabbe, SG, et al., editors. Obstetrics: normal and problem pregnancies, 7th ed. Philadelphia: Elsevier, Inc.; 2017:122–35 pp.10.1016/B978-0-323-32108-2.00007-XSearch in Google Scholar
22. Ministry of Health, Labour and Welfare. Natality. In: Vital statistics in Japan 2018:9–14. Available at: https://www.mhlw.go.jp/toukei/list/dl/81-1a2.pdf [Accessed 20 May 2020]. [In Japanese].Search in Google Scholar
23. Baba, S, Goto, A, Reich, MR. Recent pregnancy trends among early adolescent girls in Japan. J Obstet Gynaecol Res 2014;40:125–32. https://doi.org/10.1111/jog.12138.Search in Google Scholar PubMed
24. Japan Tobacco, Inc. National tobacco smoker survey 2018. Available at: https://www.jti.co.jp/corporate/enterprise/tobacco/data/smokers/index.html [Accessed 20 May 2020]. [In Japanese].Search in Google Scholar
© 2020 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Reviews
- Pooled prevalence estimates of malocclusion among Indian children and adolescents: a systematic review and meta-analysis
- Nutrition knowledge and its relation with dietary behaviour in children and adolescents: a systematic review
- Original Articles
- Water polo-related injuries among adolescents and young adults treated at emergency departments
- Service evaluation and retrospective audit of electronic HEEADSSS (e-HEEADSSS) screening device in paediatric inpatient service in Western Australia
- Association between intelligent quotient and oral health conditions among 13–15 year old intellectually disabled children
- To be or not to be in the social media arena? The perspective of healthcare providers working within adolescent and young adult oncology in Switzerland
- Human papillomavirus vaccine series follow-through: comparison of four clinics in an academic medical center
- Oral health knowledge, attitude and practice among adolescents in Kuwait
- Identifying challenges in promoting adolescent preventive health care in the primary care setting of urban Japan
- Health profile with body mass index and physical fitness in Swedish adolescents: a cross-sectional study
- Psychodermatologic pathology in adolescents: findings from the Colombian National Mental Health Survey
- Association between sitting posture on school furniture and spinal changes in adolescents
- Influence of dietary and activity patterns on weight status of Ukrainian school aged children
- A national guideline for youth-friendly health services developed by chronically ill young people and health care professionals – a Delphi study
