Analysis of rising cases of adolescent opioid use presentations to the emergency department and their management.

OBJECTIVE: We sought to answer the question of how adolescents (ages 12-17 years old) with opioid-related presentations are currently managed in the ED. The two main outcomes were the proportion of visits where naloxone and buprenorphine were both used and prescribed, and the rate of revisits to the emergency department in the six months following ED presentation. METHODS: This was a multi-center retrospective cross-sectional study. We studied patients presenting to the ED who were 12-17 years old with an opioid-related presentation. RESULTS: Two-hundred and thirty-one patients were identified out of 571 encounters screened. Of these presentations, 77/231 (33%) were girls and 154/231 (67%) were boys. The majority of patients were Latino (64%; n=147); 26% were white (n=59), 6% were middle eastern or Arab (14), and 4% were black (10). Incidence of opioid use disorder per 100,000 presentations increased by 2800% from 2014 to 2022 (21/100,000 +/- 10 [2014] to 600/100,000 +/- 50 [2022]). A plurality of cases was related to opioid withdrawal (42%; 97). On discharge from the ED, 29% of patients received naloxone. For patients in withdrawal, 4% received a prescription for buprenorphine. Twenty-nine percent of patients had a return to the ED in the six months following initial visit. CONCLUSIONS: Adolescent opioid-related presentations to the ED are rapidly increasing. Increasing ED presentations, compounded by a high 6-month revisit rate, pose a management challenge amid limited outpatient resources for this population. Opioid agonist therapy and naloxone are not routinely provided. Increasing the use of both are two ways to improve the quality of care for this population.

Diagnosing Acute HIV Infection.

Acute HIV infection (AHI) represents the first 6 to 12 weeks of the disease process, when the virus is aggressively replicating in the lymphoid tissues. Accordingly, high viral loads are often present during this phase, with declining lymphocyte levels, as the CD4+ T-cell subset is preferentially commandeered to facilitate viral reproduction. Detection at this stage is imperative-the affected are often unaware, but highly infectious. Unfortunately, correct diagnosis of AHI can be challenging because the more traditional, frequently used tests, which rely on antibody detection, will often produce false-negative results during the "window period" (usually 3 to 4 weeks from infection) due to slow production of HIV antibodies. Consequently, testing with fourth-generation antibody-antigen and viral nucleic acid polymerase chain reaction modalities, which can yield positive results within 5 to 7 days of infection, is vital in the context of any significant concern for AHI. [Pediatr Ann. 2017;46(2):e47-e50.].

Racial/Ethnic Difference in HIV-related Knowledge among Young Men who have Sex with Men and their Association with Condom Errors.

OBJECTIVE: HIV disproportionately affects young men who have sex with men, and knowledge about HIV transmission is one factor that may play a role in high rate of infections for this population. This study examined racial/ethnic differences in HIV knowledge among young men who have sex with men in the USA and its correlation to condom usage errors. DESIGN: Participants included an ethnically diverse sample of 344 young men who have sex with men screened from an ongoing longitudinal cohort study. Eligible participants were between the ages of 16 and 20 years, born male, and had previously had at least one sexual encounter with a man and/or identify as gay or bisexual. This analysis is based on cross-sectional data collected at the baseline interview using computer assisted self-interviewing (CASI) software. SETTING: Chicago, IL, USA. METHOD: We utilised descriptive and inferential statistics, including ANOVA and Tukey's Post hoc analysis to assess differences in HIV knowledge by level of education and race/ethnicity, and negative binomial regression to determine if HIV knowledge was associated with condom errors while controlling for age, education and race/ethnicity. RESULTS: The study found that Black men who have sex with men scored significantly lower (average score=67%; p<.05) than their White counterparts (average score=83%) on a measure of HIV knowledge (mean difference=16.1%, p<.001). Participants with less than a high school diploma and those with a high school diploma/GED only had lower knowledge scores, on average (66.4%, 69.9%, respectively) than participants who had obtained post-high school education (78.1%; mean difference=11.7%, 8.2% respectively, ps<.05). In addition, controlling for age, race and level of education, higher HIV knowledge scores were associated with fewer condom errors (Exp B =.995, CI 0.992-0.999, p<0.05). CONCLUSION: These findings stress the need to for increased attention to HIV transmission-related educational activities targeting the social realities and unique risk mechanisms of young men who have sex with men.