Malnutrition from anorexia nervosa triggers severe complications of hereditary spherocytosis in an adolescent girl: A case report.

Hemolytic crises and aplastic crises in hereditary spherocytosis (HS) are most commonly triggered by viral infections. We present the case of an adolescent girl with HS who developed unexpected and life-threatening complications of her inherited hemolytic anemia as a consequence of anorexia nervosa and severe malnutrition.

A Brief Provider Training Video Improves Comfort With Recommending the Human Papillomavirus Vaccine.

The American Academy of Pediatrics California Chapter 3 created a 20-minute training video targeting barriers to strong provider recommendation of the human papillomavirus (HPV) vaccine. The video included clinical vignettes featuring pediatricians modeling counseling techniques with vaccine-hesitant families. Ninety-six multidisciplinary providers (including pediatric residents) at 6 sites viewed the video and completed baseline and posttest questionnaires assessing their vaccine knowledge, attitudes toward vaccination, and comfort with skills needed to facilitate vaccination. Following the intervention, providers had substantial and statistically significant ( P < .05) improvements in multiple areas assessed, particularly knowledge of the burden of HPV-related disease in males and changes in vaccine response with age; likelihood of "strongly agreeing" that vaccination should not be delayed beyond preadolescence and that HPV vaccine is safe; and feeling "very comfortable" counseling vaccine-hesitant parents and facilitating vaccine completion. This cost-effective and easily disseminated training modality shows promise in increasing provider comfort with HPV vaccine counseling.

Outcomes of an inpatient refeeding protocol in youth with anorexia nervosa: Rady Children's Hospital San Diego/University of California, San Diego.

BACKGROUND: Current guidelines for nutritional rehabilitation in hospitalized restrictive eating disorder patients recommend a cautious approach to refeeding. Several studies suggest that higher calorie diets may be safe and effective, but have traditionally excluded severely malnourished patients. The goal of this study was to evaluate the safety of a higher calorie nutritional rehabilitation protocol (NRP) in a broad sample of inpatients with restrictive eating disorders, including those who were severely malnourished. METHODS: A retrospective chart review was conducted among eating disorder inpatients between January 2015 and March 2016. Patients were started on a lower calorie diet (≤1500 kcals/day) or higher calorie diet (≥1500 kcals/day). Calorie prescription on admission was based on physician clinical judgement. The sample included patients aged 8-20 years with any DSM-5 restrictive eating disorder. Those who were severely malnourished (<75% expected body weight [EBW]) or required tube feeding during admission were included. Multivariable regression models were used to determine whether level of nutritional rehabilitation was associated with hypophosphatemia, hypomagnesemia, or hypokalemia. RESULTS: The sample included 87 patients; mean age was 14.4 years (S.D. 32.7); 29% were <75% EBW. The majority (75.8%) was started on higher calorie diets (mean 1781 kcal/day). Controlling for rate of calorie change, initial %EBW, age, race/ethnicity, insurance, diagnosis, and NG/NJ tube placement, higher calorie diets were not associated with hypophosphatemia, hypomagnesemia, or hypokalemia on admission or within the first 72 h. Increased risk of hypophosphatemia on admission was associated with lower baseline %EBW. CONCLUSION: A higher calorie NRP was tolerated in this broad population of inpatients with restrictive eating disorders. Lower %EBW on admission was a more important predictor of hypophosphatemia than initial calorie level. Larger studies are required to demonstrate the safety of higher calorie diets in severely malnourished patients.

Reach Out and Read is Feasible and Effective for Adolescent Mothers: A Pilot Study.

OBJECTIVES: The Reach Out and Read program (ROaR) is associated with increased parent-child book reading and improved language development in children. Though children of adolescent parents may have an elevated risk of language delay, ROaR has never been specifically studied among adolescent-headed families. This pilot evaluated the feasibility and effectiveness of ROaR among adolescent mothers and their children. METHODS: This randomized controlled pilot followed thirty adolescent mothers with children aged 6-20 months in a teen-tot clinic in downtown Toronto. At each of three consecutive well child checkups, intervention families received a new children's book, reading-related anticipatory guidance customized to the mother's developmental stage, counselling from a librarian, and a public library card. Control families received routine care. At baseline and study completion, all mothers completed a survey on family reading patterns and the Beck Depression Inventory-Revised (BDI-IA). RESULTS: Though regression models were not statistically significant, bivariate analyses at study completion revealed that intervention mothers were significantly more likely than controls to report reading as one of the child's favorite activities (29 vs 0 %) and had significantly lower maternal depression scores (7.0 vs 12.5; ≥10 = clinically significant depression). Trends for all other variables, including time spent reading together and maternal enjoyment of reading, were also in the direction of benefit. This program was implemented at minimal cost and adopted permanently following study completion. CONCLUSIONS: This feasible and developmentally appropriate intervention shows promise in promoting shared book reading and reducing maternal depression within adolescent-headed families, warranting investigation with larger trials.

Housing and sexual health among street-involved youth.

Street-involved youth (SIY) carry a disproportionate burden of sexually transmitted diseases (STD). Studies among adults suggest that improving housing stability may be an effective primary prevention strategy for improving sexual health. Housing options available to SIY offer varying degrees of stability and adult supervision. This study investigated whether housing options offering more stability and adult supervision are associated with fewer STD and related risk behaviors among SIY. A cross-sectional study was performed using public health survey and laboratory data collected from Toronto SIY in 2010. Three exposure categories were defined a priori based on housing situation: (1) stable and supervised housing, (2) stable and unsupervised housing, and (3) unstable and unsupervised housing. Multivariate logistic regression was used to test the association between housing category and current or recent STD. Secondary analyses were performed using the following secondary outcomes: blood-borne infection, recent binge-drinking, and recent high-risk sexual behavior. The final analysis included 184 SIY. Of these, 28.8 % had a current or recent STD. Housing situation was stable and supervised for 12.5 %, stable and unsupervised for 46.2 %, and unstable and unsupervised for 41.3 %. Compared to stable and supervised housing, there was no significant association between current or recent STD among stable and unsupervised housing or unstable and unsupervised housing. There was no significant association between housing category and risk of blood-borne infection, binge-drinking, or high-risk sexual behavior. Although we did not demonstrate a significant association between stable and supervised housing and lower STD risk, our incorporation of both housing stability and adult supervision into a priori defined exposure groups may inform future studies of housing-related prevention strategies among SIY. Multi-modal interventions beyond housing alone may also be required to prevent sexual morbidity among these vulnerable youth.

Sexual knowledge of Canadian adolescents after completion of high school sexual education requirements.

BACKGROUND: Formal sexual education is a mandatory component of the high school curriculum in most Canadian provinces. The present study was a preliminary assessment of sexual knowledge among a sample of Ontario adolescents who had completed their high school sexual education requirements. METHODS: A questionnaire, testing understanding of the learning objectives of Ontario's minimally required high school sexual education course, was distributed in a paediatric emergency department to 200 adolescent patients who had completed the course. RESULTS: Respondents demonstrated good understanding of pregnancy physiology and sexually transmitted infections, but poor understanding of concepts related to reproductive physiology, contraception, HIV/AIDS and sexual assault. Most respondents could not identify Canada's age of sexual consent. CONCLUSIONS: Respondents demonstrated concerning gaps in sexual knowledge despite completion of their sexual education requirements. Further studies must determine whether a representative, population-based student sample would exhibit similar findings. Sexual education currently offered in Ontario may require investigation.

HISTORIQUE: L'éducation sexuelle est un élément obligatoire du programme d'études secondaires de la plupart des provinces canadiennes. La présente étude visait à obtenir une évaluation préliminaire des connaissances en matière de sexualité d'un échantillon d'adolescents ontariens qui avaient terminé leur cours d'éducation sexuelle au secondaire. MÉTHODOLOGIE: Lors de leur visite au département d'urgence pédiatrique, 200 patients adolescents qui avaient terminé leur cours d'éducation sexuelle ont reçu un questionnaire afin de vérifier leur compréhension des objectifs d'apprentissage du cours d'éducation sexuelle de base offert dans les écoles secondaires de l'Ontario. RÉSULTATS: Les répondants ont démontré une bonne compréhension de la physiologie de la grossesse et des infections transmises sexuellement, mais une mauvaise compréhension des concepts liés à la physiologie de la reproduction, à la contraception, au VIH-sida et aux agressions sexuelles. La plupart des répondants ne pouvaient pas préciser l'âge du consentement sexuel au Canada. CONCLUSIONS: Les répondants ont démontré des lacunes préoccupantes en matière de connaissances sexuelles, même s'ils avaient terminé leur cours d'éducation sexuelle obligatoire. D'autres études devront déterminer si un échantillon d'étudiants représentatifs en population donnerait des résultats similaires. Les cours d'éducation sexuelle actuellement offerts en Ontario méritent peut-être d'être évalués.

Transient blindness as the primary symptom of acute hyponatremia post surgery.

Hyponatremia is a common electrolyte abnormality among children and adults. Visual disturbance associated with hyponatremia has been described in the past; however, all of these cases presented primarily with other classical signs and symptoms of hyponatremia, such as seizures, gastrointestinal upset, lethargy, or headache. We present a child who developed blindness on post-operative day #6 after resection of a brain tumour. Computed tomography of the head showed no new bleed, mass lesion, edema, or occipital lobe pathology. Laboratory evaluation revealed acute hyponatremia (115 mmol/L). No other obvious symptoms of hyponatremia were present prior to its identification. As her hyponatremia was gradually corrected, her blindness completely resolved. This is the first reported patient with acute hyponatremia to present primarily with blindness; a "precondition" of chronically increased intracranial pressure (first hit) compounded by acute hyponatremia (second hit) may have induced reversible visual loss. Checking electrolytes should be the standard of care for neurosurgical patients with acute visual disturbance or other unexplained symptoms. It is a simple measure that quickly identifies a dangerous but reversible condition.