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From Russia with Love

posted 4 Jun 2014, 01:04 by Damian Wood   [ updated 4 Jun 2014, 01:06 ]
Russia’s adolescent medicine has experienced periods of prosperity and decline. After the October Revolution, in 1918, Russian child and adolescent health facilities for the first time became the key institutions to protect adolescents’ health. Since 1936, medical services were provided separately for children and adolescents. General population medical facilities (Polyclinics) included one-room adolescent units equipped with adolescent health physician responsible for coverage of 1,500 adolescent population (15-18 years).  Ambulatory services for adolescents were provided in general hospitals.

In the beginning of the 1980s, the USSR Ministry of Health significantly improved the health care provision for adolescents. A system of annual preventive check-ups was introduced and therapeutic adolescent departments have been established within general population health facilities. A key task for the adolescent physician has been defined as treatment and prevention of chronic and somatic diseases and preparation of healthy youth for labour activity.

Faculties of adolescent physiology and pathology at post-graduate training institutions in Kharkov, Leningrad and Moscow were specifically created to train internal medicine specialists or paediatricians on adolescent health specifics.

The lack of continuity in medical services provision for adolescents moving from children polyclinic to general population ones became a serious issue.  To eliminate any contradictions, pediatricians proposed to provide health services for adolescents up to 18 years in children polyclinics, especially in light of the drastic decrease in birth rate in 1990s that put the same existence of pediatric system up in the air. Thus, since 1999, both children and adolescents were served in children’s polyclinics. Separate position of adolescent physician has been abolished and all children under 18 were served by pediatricians. Training for pediatricians on specifics of working with adolescents was provided in Russia only by the Adolescent Medicine Department in St. Petersburg Medical Academy of Post-graduate Studies.

At present health care for adolescents is provided by pediatricians in local children’s polyclinics, but their counseling approaches tend to be tailored towards the needs of young children. With an average of 12 to 15 minutes for each patient, doctors are not well-prepared to address adolescents’ specific counseling needs.   Adolescents who have had long-term relationships with their local pediatricians are often embarrassed to discuss difficult issues such as contraception or sexually transmitted infections, and may also worry about breaches of confidentiality, thus the majority of them visit physicians only in case of acute disease or escalation of chronic somatic ones. Russia’s pediatric health care system did not address adolescents’ specific problems, which have grown over the 10-15 years with consequences of higher risky behaviour and increased problems in their reproductive and mental health.

To address adolescent health specific needs since 2000 in Russia a concept of adolescent-friendly health services, a model that provides young people with an easily accessible range of age-appropriate health, social, psychological and information services, has been developed and promoted with UNICEF Russia support. Training and retraining of professionals capable to work with adolescents, is provided by Youth-friendly services Training and methodological center and a Russian speaking branch of EuTEACH established on the basis of the St. Petersburg Medical Academy of Post-graduate Studies (now North-Western State Medical University named after I.I. Mechnikov) for specialists from Russia and CIS countries.

Within “traditional” pediatric community there is also clear (and rising in the last years) interest to adolescent health issues. In 2010, the Russian Union of Pediatricians made public a newly produced national strategy on “Adolescent Health and Development in Russia”, developed to harmonize European and Russian approaches to adolescent health practices, enhancing young people’s overall well-being. - information on adolescent medicine in Russia and Russian speaking branch of EuTEACH