Recovery Trajectories in Adolescent Girls with Anorexia Nervosa.

Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.

Anorexia Nervosa in Adolescence: A Comprehensive Study of Multidimensional Factors Associated with Symptom Severity 1 Year Following the Diagnosis.

The overarching goal of this study was to examine the unique contribution of psychological, familial, and friendship factors in explaining anorexia nervosa (AN) symptom severity 1 year following diagnosis among a sample of adolescent girls. A second objective was to determine whether friendship factors mediated the association between psychological and/or familial factors and AN symptom severity. This study included 143 adolescent girls under the age of 18 diagnosed with AN (M = 14.84, SD = 1.31). Participants were recruited from specialized eating disorder treatment programs. At admission (T1), participants completed a set of self-report questionnaires measuring psychological, familial, and friendship factors. AN symptom severity was assessed 1 year later (T2). Results of hierarchical regression analysis revealed that greater general psychological maladjustment at T1 (b = .26; se = .03; p = .00) was associated with greater AN symptom severity at T2. Greater alienation from friends at T1 (b = 1.20, se = .53, p = .03) also predicted greater AN symptom severity at T2, above and beyond the influence of adolescent girls' general psychological maladjustment. Finally, the mediating role of alienation from friends in the association between general psychological maladjustment at T1 and AN symptom severity at T2 was also identified. AN is a multidimensional disorder with a prognosis that involves both psychological and social factors. The results stemming from the present study shed light on the role of peer as a mechanism through which general psychological maladjustment is linked to AN symptom severity 1 year following diagnosis.

Can youth-engaged research facilitate equitable access to contraception in Canada? The qualitative study protocol for the Ask Us project.

INTRODUCTION: There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. METHODS AND ANALYSIS: This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque's Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers. ETHICS AND DISSEMINATION: Ethical approval was received from the University of British Columbia's Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations.

Accessibility of emergency contraception for adolescents in Quebec community pharmacies.

OBJECTIVE: Access to effective contraceptives, including emergency contraception (EC), is critical to reducing unintended adolescent pregnancy. This study evaluates the accessibility of Ln-EC (levonorgestrel EC) for adolescents in Quebec community pharmacies. METHODS: We conducted an anonymous self-administered electronic survey of Quebec community pharmacists between June 1, 2016 and October 31, 2016. Pharmacists were asked about the availability of Ln-EC in their pharmacy, whether they prescribed Ln-EC, and their experience with adolescents who requested Ln-EC. RESULTS: Five hundred and ninety-one pharmacists responded, with representation from across the province. Ninety-five per cent had Ln-EC in stock. Most pharmacists (90%) reported being comfortable prescribing Ln-EC, though they were less comfortable prescribing to adolescents than to adults (*P<0.001). Pharmacists also reported that cost and confidentiality are barriers to accessing Ln-EC for some adolescents. CONCLUSIONS: This study indicates that availability and pharmacist comfort are not likely to be barriers to Ln-EC use for adolescents. On the other hand, cost and/or confidentiality do represent a barrier for some adolescents. This study lays the groundwork for a national study examining the accessibility of EC for adolescents.

Can youth get the contraception they want? Results of a pilot study in the province of Quebec.

OBJECTIVES: Canadian contraceptive providers report many barriers to access to contraception, and perceive youth as particularly vulnerable to these barriers. This study explores Quebec youth's experience of obtaining contraception. METHODS: A convenience sample of Quebec youth (aged 14 to 21 years) participated in an online anonymous survey of their experiences obtaining contraception. Data were collected between June 1, 2016 and December 31, 2016. RESULTS: One hundred and five youth were eligible to participate. Of these, 95 had used at least one form of contraception. Twelve (13%) reported not being able to obtain their preferred method of contraception, with cost being the most common barrier (N=10). Eleven participants (12%) stopped using their preferred contraceptive method: cost was a factor in four cases, and difficulty with access to the clinic/prescription in seven. Youth who required confidential access experienced more difficulty obtaining contraception (P<0.01). CONCLUSION: Despite benefitting from universal pharmacare and a network of youth sexual and reproductive health clinics, Quebec youth still experience barriers to obtaining and continuing their preferred contraceptive. Youth who desire confidential care are more likely to experience difficulty obtaining contraception.

Universal access to no-cost contraception for youth in Canada.

Timely access to effective contraception reduces the incidence of unintended pregnancy. Cost is a significant barrier to using contraception for youth in Canada. Many must pay out-of-pocket because they have no pharmaceutical insurance, their insurance does not cover the contraceptives they desire, or they wish to obtain contraceptives without their parents' knowledge. To address these barriers and reduce rates of unintended pregnancy, this statement recommends that all youth should have confidential access to contraception, at no cost, until the age of 25. The statement also recommends measures to help achieve this goal across Canada.

Contraceptive care for Canadian youth.

Sexual and reproductive health is an important component of comprehensive health care for youth. This statement provides guidance for selecting and prescribing contraceptives for youth, including commonly prescribed hormonal contraceptives-the pill, patch, ring and injectable progestin-and long-acting reversible contraceptives (LARCs). LARCs, including subdermal implants (which are not available in Canada) and intrauterine contraceptives (IUCs), are substantially more effective during typical use than hormonal contraceptives. This statement endorses LARCs as the first-line option for contraception for Canadian youth, while emphasizing that providers must collaborate with youth to select a contraceptive method that is acceptable, safe, effective and practical for them. Strategies that eliminate obstacles to initiating and continuing contraception are provided.

Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa.

PURPOSE: The initial goal of admission for a patient with anorexia nervosa is physiologic stabilization through nutritional rehabilitation balanced against the risk of refeeding syndrome. Recent alternative approaches emphasize meal composition, limiting carbohydrates, to reduce risk. The Montreal Children's Hospital has instituted a standardized high-calorie continuous nasogastric (NG) refeeding protocol for the initial management of inpatient adolescents with restrictive eating disorders. This study aims to confirm that this protocol results in a shorter admission duration and faster rate of weight gain without increased incidence of complications. METHODS: Retrospective chart review of patients with restrictive eating disorders admitted to the Montreal Children's Hospital during December 2003 to December 2011. Those treated with higher calorie NG refeeding protocol (N = 31) were compared with those managed with a standard bolus meal treatment (N = 134). RESULTS: Length of stay was significantly reduced in the NG-fed cohort (NG cohort 33.8 days; bolus-fed cohort 50.9 days; p = .0002). Mean rate of weight gain in the NG group was significantly improved for both the first and second week when compared with the bolus-fed cohort (1.22 kg/week (1), p = .01; 1.06 kg/week (.9), p = .04). No significant difference was found in the rate of complications or electrolyte abnormalities with 90% of the NG-fed cohort receiving prophylactic phosphate supplementation from admission. CONCLUSIONS: This study provides further evidence to support the treatment of undernourished inpatients with restrictive type eating disorders with a higher initial caloric intake to achieve rapid and safe nutritional rehabilitation.

Include them and they will tell you: learnings from a participatory process with youth.

Encouraging youth voice, visibility, and active participation in adolescent-related research is strongly advocated in the literature. In this article, we describe how participatory approaches informed by arts-based methods (e.g., reflective writing, dramatization) were used with adolescents to enhance the research process in an exploratory study designed to develop and evaluate prevention resources for sexual risk-taking behaviors.Youth aged 15 to 17 years participated in iterative focus groups conducted over a 1-year period in school settings in Prince Edward Island, Canada. Descriptions of our experiences, strategies, and insights provide evidence for guiding practice to optimize adolescent participation in research.