The Future of Sexually Transmitted Infection Research: Understanding Adolescent Perspectives for Implementation of a Chlamydia Vaccine.

PURPOSE: Despite advancements in developing a vaccine for Chlamydia trachomatis (CT), vaccine hesitancy has historically limited the adoption of sexually transmitted infection immunization. This report investigates adolescent perspectives toward a potential CT vaccine and vaccine research. METHODS: As part of the Technology Enhanced Community Health Nursing (TECH-N) study, conducted from 2012-2017, we surveyed 112 adolescents and young adults aged 13-25 years who presented with pelvic inflammatory disease regarding their perspectives on a CT vaccine and willingness to participate in vaccine research. Descriptive statistical analyses were conducted. RESULTS: Most participants were African American (95%), on Medicaid (89%), and sexually experienced (100%). Most respondents would accept a vaccine (95%) and preferred a provider's recommendation (86%) over parents, partners, or friends. A majority (70%) would not be embarrassed to participate in research. DISCUSSION: Respondents showed favorable attitudes toward CT vaccination and research in this high-risk study population.

Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap.

Atypical anorexia nervosa (AAN) is a restrictive eating disorder (ED) that describes individuals who may be normal weighted or overweight; many have a premorbid history of obesity. Pediatric care providers are trained to identify and provide best practices for youth with pediatric obesity; however, most pediatric care providers are not trained to assess and treat restrictive EDs which typically present in youth aged 10 and 14 years. Although individuals with AAN may appear to be within a 'healthy weight', many experience malnutrition, psychological symptoms, and severe physiological complications after weight loss. These individuals are presenting to pediatric services at an increasing rate and exhibit acute medical instability along with severe ED psychopathology. One complicating factor is youth with AAN may take longer to be identified by pediatric providers and may be reluctant to engage in treatment. Delayed treatment for AAN, along with all EDs often results in poorer treatment outcomes. A greater understanding of this complex illness is essential to inform medical decisions, such as labs, vitals, hospital admissions, and psychological therapy. Currently, there are no standardized guidelines for treating AAN in youths. This review is designed to present evidence-based treatment to inform and guide best treatment practices.

Using Reproductive Health as a Strategy to Engage Youth in Preventive Care.

PURPOSE: This research examined differences in receipt of recommended preventive services by contraceptive use in adolescent and young adult (AYA) women. METHODS: Data are from a retrospective chart review of 408 AYA women who received sexual health risk reduction counseling in an urban academic AYA clinic. Descriptive, bivariate, and logistic regression analyses were used to examine relationships between contraception use and receipt of care. RESULTS: AYA women aged 12-24 years using hormonal contraception were more likely to receive recommended preventive care, including an annual preventive visit and sexually transmitted infection screening, compared with those using condoms or no contraception. Women using medium-acting reversible contraception were more likely to have an annual visit compared with those not using hormonal contraception. CONCLUSIONS: AYA women using contraception are more likely to receive recommended preventive health services, suggesting reproductive health visits may be used to promote engagement around preventive care.

Please Be Careful with Me: Discrepancies between Adolescent Expectations and Clinician Perspectives on the Management of Pelvic Inflammatory Disease.

STUDY OBJECTIVE: To compare clinician perspectives for the treatment of pelvic inflammatory disease (PID) with those of adolescent patients and parents. DESIGN: Cross-sectional study. SETTING: Urban academic pediatric and adolescent medicine practices and school-based health clinics in a large urban community with a high prevalence of sexually transmitted infections and a national sample of adolescent-serving clinicians. PARTICIPANTS: Female patients aged 12-19 years, parents raising an adolescent older than the age of 12 years in the urban community, and clinicians who serve adolescents recruited from regional and national listservs. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Visual analogue scale scores on a scale of 0-10 corresponding to preferences on patient disposition in 17 clinical scenarios for a hypothetical patient with PID. RESULTS: Compared with adolescents, clinicians were significantly more likely to endorse hospitalizations when patients presented with severe or complicated illness (ß = 0.9; standard error [SE], 0.22; P < .001), possible surgical emergency (ß = 0.83; SE, 0.2; P < .001), concurrent pregnancy (ß = 0.59; SE, 0.3; P = .046), or failure of outpatient treatment (ß = 0.58; SE, 0.29; P = .045). Compared with clinicians, adolescents were significantly more likely to endorse hospitalizations when patients presented at a young age (ß = 1.36; SE, 0.38; P < .001), were homeless (ß = 0.88; SE, 0.32; P = .007), were afraid to inform a partner (ß = 1.66; SE, 0.40; P < .001), or had unaware parents (ß = 2.86; SE, 0.39; P < .001). CONCLUSION: Clinicians were more likely to recommend hospitalization when doing so adhered to national guidelines on PID treatment. Adolescents opted for hospitalization more often than clinicians in scenarios in which patients exhibited social vulnerability. Clinicians should engage with adolescents in shared disposition planning and use a more nuanced approach to PID management for adolescents who might not be able to tolerate an outpatient regimen.