Sexual and reproductive health screening and counseling in adolescent and young adult transplant recipients.

Adolescents and young adults with and without chronic illnesses partake in risk-taking behavior. Clinicians in transplant clinics should be aware of the prevalence of risk-taking behavior in their adolescent and young adult solid organ transplant patients in order to provide complete care. Creating an environment where teens and young adults feel comfortable discussing risky behavior is important and includes creating a privacy policy and increasing comfort of the healthcare provider in asking sensitive questions. This review is intended to help the providers in the transplant clinic screen for and counsel about risk-taking behaviors with their adolescent and young adult patients, specifically around sexual and reproductive health.

At-Home Self-Collection of Urine or Vaginal Samples for Gonorrhea and Chlamydia Screening Among Young People Who Were Assigned Female at Birth.

Introduction: The U.S. has seen a rise in sexually transmitted infections; the need to increase access to screening is essential to reverse this trend, especially for vulnerable populations such as lesbian, gay, bisexual, and transgender/transsexual plus individuals, people of color, or those at a low SES. This study's primary objective is to assess preferences among people who were assigned female at birth for at-home self-collection for gonorrhea and chlamydia screening. This study aims to provide insight into the need for clinicians to adopt at-home self-collection of urine or vaginal samples to improve access to sexually transmitted infection screening. Methods: A recruitment mailer was distributed in September-October 2021. Inclusion criteria included established patients (seen within the last 3 years for clinical services either in person or through telemedicine) at a local urban federally qualified health center in the state of Wisconsin, assigned female at birth, aged 18-24 years, and speaking English language. Participants completed an anonymous online survey regarding their preferences, experiences, and likelihood of self-collecting either urine or vaginal samples for gonorrhea and chlamydia screening at home. Results: Among the total participants (N=88), 69% (n=61) overall preferred home collection for screening with no significance based on age; lesbian, gay, bisexual, and transgender/transsexual plus status; and race and/or ethnicity. However, patients were less likely to prefer at-home self-collection screening if they had lower educational attainment (OR=0.25; 95% CI=0.08, 0.77; p<0.05), lacked insurance (OR=0.19; 95% CI=0.06, 0.67; p<0.05), or were unemployed (OR=0.28; 95% CI=0.08, 0.95; p<0.05). Conclusions: There is overall acceptability for at-home self-collection sexually transmitted infections screening (61 of 88=0.69; 95% CI=0.59, 0.79). Primary care clinics can expand needed screening by integrating such methods into workflows for established patients. Although this study showed that patients who are employed, attained a higher education level, and have their own insurance may prefer at-home self-collection, there is a need to focus on social determinants of health to decrease rising sexually transmitted infection rates in the U.S.

A Survey of Eating Attitudes and Behaviors in Adolescents and Adults With Phenylalanine Hydroxylase Deficiency.

INTRODUCTION: Phenylalanine hydroxylase deficiency, commonly known as phenylketonuria (PKU), is an inborn error of metabolism that manifests in severe neurological damage when left untreated. Routine newborn screening has made early identification and treatment of affected individuals possible, changing the prognosis of PKU from devastating to excellent. The most effective treatment for PKU involves lifelong dietary restriction of protein, nutrition supplementation via medical foods, and frequent monitoring of amino acid levels in the blood. However, it has been observed that imposing strict medical control over daily dietary habits can lead to destructive attitudes towards eating and body image. This study investigated whether people with PKU are at increased risk of disordered eating behaviors and attitudes. METHODS: Fifteen patients with PKU between the ages of 12 and 35 from the University of Wisconsin (UW) Biochemical Genetics Clinic were surveyed about their metabolic management and eating attitudes and behaviors. RESULTS: While this study was too small to make conclusions of clinical significance, our findings did suggest that patients with poor metabolic control exhibited symptoms of disordered eating at a higher frequency than those with good metabolic control. CONCLUSIONS: There is currently no validated screening tool to evaluate for disordered eating behaviors in individuals with PKU, which makes identifying and treating disordered eating and related conditions difficult. The development of this project emphasized the importance of tailored screening and provider awareness for disordered eating for populations with chronic illnesses.

Severe edema after cessation of laxative abuse and use of a loop diuretic: Case report.

Stimulant laxatives are the class of laxatives most often abused by patients with eating disorders. The abrupt cessation of high-dose stimulant laxatives is known to cause edema. We present the case of a patient with anorexia nervosa with binge-purge subtype who was taking ∼100 stimulant laxatives per day. Upon discontinuation of stimulant laxatives, she experienced severe peripheral edema with rapid gain of 11.6 kg over 1 week. Unique features of this case include the high quantity of stimulant laxatives consumed per day, the amount of weight gained due to edema, and the 3 month duration of edema after laxative cessation. This case report details the time course of development of edema after abrupt laxative cessation. It also details the dosing and duration of furosemide used for diuresis in order to provide a precedent to inform future care. This case calls into question the best treatment approach for patients with severe edema after laxative cessation who do not meet criteria for Pseudo Bartter syndrome.

Managing Eating Disorders on a General Pediatrics Unit: A Centralized Video Monitoring Pilot.

Adolescents with severe eating disorders require hospitalization for medical stabilization. Supervision best practices for these patients are not established. This study sought to evaluate the cost and feasibility of centralized video monitoring (CVM) supervision on a general pediatric unit of an academic quaternary care center. This was a retrospective cohort study of nursing assistant (NA) versus CVM supervision for girls 12-18 years old admitted for medical stabilization of an eating disorder between September 2013 and March 2017. There were 37 consecutive admissions (NA = 23 and CVM = 14). NA median supervision cost was more expensive than CVM ($4,104/admission vs $1,166/admission, P < .001). Length of stay and days to weight gain were not statistically different. There were no occurances of family refusal of CVM, conversion from CVM to NA, technological failure, or unplanned discontinuation. Video monitoring was feasible and associated with lower supervision costs than one-to-one NA supervision. Larger samples in multiple centers are needed to confirm the safety, acceptability, and efficacy of CVM.

HPV vaccination in female children with special health care needs.

STUDY OBJECTIVE: Potential barriers between parents of children with special health needs (CSHCN) and their health care providers in regards to the patient receiving a full course of the human papillomavirus (HPV) immunization are explored in this study. STUDY DESIGN: Parents of female CSHCN between ages of 9-26 years completed a questionnaire asking about personal receptivity of vaccines and potential barriers to vaccinating their child against HPV. A separate survey was completed by members of the Wisconsin and Illinois chapters of the American Academy of Pediatrics about HPV vaccination practices provided to patients with special health care needs. SETTING: Outpatient urban health clinic and the Children's Hospital of Wisconsin's Adolescent Medicine and Neurology clinics from January 2009-2010. RESULTS: Seventeen parents completed the survey. Forty-seven percent of parents answered that their child's pediatrician had offered the HPV vaccine; 17% reported that their child was vaccinated against HPV. Most parents knew that HPV is a sexually transmitted infection, causes genital warts, and can cause abnormal pap smears. For the provider survey, 77 out of 130 respondents offer HPV vaccine as part of their practice and see CSHCN. Ninety percent have vaccinated CSHCN against HPV. CONCLUSIONS: This study suggests that acceptability of the HPV vaccine is high for health care providers, but acceptability in parents of CSHCN is lower than in the general population. This study raises awareness that health care providers need to be aware of the possibility that parents of CSHCN may not perceive their child as needing or being offered the HPV vaccine.