Pediatrics and adult medicine are not covering the new reality of people ranging in age from 12 to 25 years. There are unmet needs for this group of people , both in terms of diagnosis and therapeutics
Pediatrics in general terms has two main functions: the attention to the children with a disease and a second aspect of prevention (vaccination, diet). The “normal” development” of boys and girls is evaluated with anthropometric measures (weight, stature) and everything seems to be right when the values reach the proper quintile.
On the other hand, General Practitioners in our days have to lead with an overwhelming majority of old people with chronic diseases and a long list of pharmacological treatment. In this context some diseases with different prevalence for young people can be missed or diagnosed late.
We need to re-design our attention for this group of people, not only because of the important psychological component, but for the technical aspects related with the prevalence of different diseases, the positive or negative predictive value of the symptoms or, and not the least important, the tolerance of medication and the dose indicated, usually with a dosification fixed for adults.
CHECKLIST of unmet needs:
Family history is important in some situations such as genetic diseases (neurofibromatosis, talasemia, Gilbert, Psoriasis, and others).
Psychiatric family history
Skin lesions are not considered usually and can be very useful to prevent importan diseases in the adult life
Locomotor problems: commonly bone pain in this group of age are associated with sport activities but there are some specific entities like Sever,s disease or the Osgood-Schlatter disease, usually not diagnosed or diagnosed late.
Malignant tumors: fortunately malignant tumors are not common in this group of age but there are situations worthy of consideration: an enlarged lymphatic node usually is associated with an infection but also other entities must be considered: (Kikuchi, lymphoma). Intracranial tumors, testicular tumors, are the most common diagnosis related with this pathology . Thyroid cancer has the main incidence peak in young girls around 16 years of age.
The list could include several other situations, but we only want to enhance the different type of medical attention that they deserve as adolescents and young adults (AYA).
The psychological aspects associated with a treatment for an important disease in AYA is a crucial point because the consequences have a strong influence in the social life of the patient. The American Society of Clinical Oncology has a study group for these patients to evaluate their unmet needs.
Even the dosification is fixed for a “standard” adult , but AYA are very different in weight or stature and the problem of overdosing is real.
What is clear is that our society is changing, our population also, and the personal autonomy of AYA is something out of doubt.