The impact of parental involvement laws on minors seeking abortion services: a systematic review.

On June 24, 2022, the US Supreme Court overturned the constitutional right to abortion in Dobbs v Jackson Women's Health Organization. Minors are a vulnerable population with a high risk of unintended pregnancy who are likely to be disproportionately affected by abortion restrictions. Examining the impact of historical abortion restrictions in minors may provide insight into the anticipated effects of the Dobbs decision. This study is a systematic review examining the impact of parental involvement (PI) laws on minors seeking abortion services. Our review suggests an association between PI laws and decreased abortion rates. Parental involvement laws also may increase pregnancy and birth rates and out-of-state travel for abortion procedures and lead to later abortions, although effects appear to be heterogenous.

A systematic review of practice-, provider-, and patient-level determinants impacting Asian-Americans' human papillomavirus vaccine intention and uptake.

INTRODUCTION: Asian-Americans have been documented to have low human papillomavirus (HPV) vaccine initiation and completion. No research has attempted to examine underlying mechanisms of HPV vaccine uptake disparities among Asian-Americans. Using the P3 (practice, provider, and patient) model, this study aimed to identify practice-, provider-, and patient-level determinants of Asian-Americans' HPV vaccine intention and uptake. METHODS: We conducted a systematic review of published literature regarding practice-, provider- and patient-level determinants of vaccine intention (e.g., intention, willingness, or acceptability) and uptake (e.g., initiation or completion). Eligible studies were those presenting empirical/original data, focusing on Asian populations in the U.S., including outcomes related to HPV vaccine intention and uptake, and analyzing data on factors associated with these outcomes separately for Asian groups. RESULTS: Twenty-six studies (19 quantitative and 7 qualitative studies) were included in the review. Most commonly studied subgroups were Koreans (n = 9), Chinese (n = 6), and Cambodians (n = 5). Studies showed varied prevalence across subgroups (intention: 23.4%-72%; initiation: 14%-67%; completion: 9%-63%). Only 3 studies included measurements of practice-level determinants (language services, insurance policy). Twelve studies measured provider-level determinants (most commonly documented: HPV vaccine recommendation). All studies measured patient-level determinants (most commonly documented: HPV and HPV vaccine knowledge, perceived safety, perceived susceptibility, and perceived relationship between HPV vaccine and sexual activity). CONCLUSIONS: Existing research on determinants of HPV vaccine intention and uptake among Asian-Americans currently lacks measurements of practice-level constructs and perspectives of clinic staff and providers, which are needed to guide system-level interventions and provider training. Data regarding patient-level determinants suggest that interventions for Asian-American populations can focus on providing educational information in culturally-appropriate manners, leveraging familial influences, and attending to access-related or cultural beliefs about HPV vaccine. Interventions should take into account varied vaccine intention and uptake prevalence in different Asian subgroups.

Childhood vitiligo.

Vitiligo is a common skin disorder in which pigment is lost from the skin and adnexae. Half of all cases begin before the age of 20 years. Until recently, there was a paucity of published data regarding effective therapy of vitiligo. Current therapy is quite effective, and while many patients may not experience complete repigmentation, 50% to 75% repigmentation of vitiligo with recent onset routinely can be expected with available therapeutics.

Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases.

BACKGROUND: Vitiligo is an autoimmune disorder characterized by loss of pigmentation. Phototherapy and application of topical corticosteroids are most commonly prescribed. However, these therapies are often not effective and use of corticosteroids on the face may lead to cutaneous atrophy, telangiectasia, and ocular complications. OBJECTIVE: We sought to assess the efficacy of topical tacrolimus ointment in the treatment of pediatric vitiligo. METHODS: A retrospective review was performed of 57 pediatric patients with vitiligo at two clinical sites. Patients were treated with tacrolimus ointment for at least 3 months. Clinical responses were documented during clinic visits, and by pretacrolimus and posttacrolimus photography. RESULTS: At least partial response was noted to tacrolimus ointment on the head and neck in 89%, and on the trunk and extremities in 63% of patients. Facial vitiligo of the segmental type showed the best response rate. Two patients initially experienced burning on application. CONCLUSIONS: Topical tacrolimus ointment is an effective alternative therapy for childhood vitiligo, particularly involving the head and neck.

Getting to know human papillomavirus (HPV) and the HPV vaccines.

More than 100 types of human papillomavirus (HPV), of which more than 40 are transmitted sexually, affect men and women. The worldwide prevalence of cervical HPV infection is approximately 10%. The most common HPV types worldwide are 16 and 18, which are the main causative viruses for cervical cancer and are both preventable by vaccination. Two HPV vaccines are currently approved in the United States: the quadrivalent HPV recombinant vaccine in males and females and the bivalent HPV recombinant vaccine in females. The Advisory Committee on Immunization Practices does not recommend routine use of the quadrivalent vaccine in males. The vaccines have been demonstrated to be highly effective in preventing cervical dysplasia, vulvar cancer, and genital warts related to HPV types 6, 11, 16, and 18; they are most effective, however, in vaccinees who have never been infected with HPV. Based on a review of the literature, the authors argue that it may be appropriate to routinely vaccinate both males and females to prevent the spread of HPV types 6, 11, 16, and 18.

Factors affecting specialty choice among osteopathic medical students.

PURPOSE: The availability of primary care directly and favorable affects the health status of local communities. This study shows the predictors and characteristics of osteopathic medical students who chose a primary care specialty (PCS). METHOD: The authors surveyed 2,345 fourth-year osteopathic medical students during 2003-2004. A total of 1,882 (80%) responded. By means of their survey, the authors examined many aspects of the students' experiences and other factors in relation to choice of a PCS versus a nonprimary nonsurgical specialty (NPCS) and compared their findings against findings in the allopathic specialty-choice literature. RESULTS: Dealing with people was favored by those entering a PCS, whereas the NPCS group cited technical skills, prestige and income, and lifestyle as being highly influential. Both PCS and NPCS respondents favored dually accredited programs (American Osteopathic Association-Accreditation Council for Graduate Medical Education). Women showed a slightly greater preference for a PCS, whereas men overwhelmingly chose an NPCS. Those who anticipated practicing in cities of fewer than 100,000 citizens tended to choose a PCS. Those individuals choosing a PCS expect their income to be less than those choosing an NPCS. Debt showed a monotonic influence on specialty choice, with respondents who had greater debt favoring NPCSs. CONCLUSIONS: No single factor reliably predicts specialty choice; it is a complex decision-making process. There are modifiable factors (debt) and nonmodifiable factors (gender) that influence specialty choice. The study's findings suggest that positively influencing the modifiable risk factors will increase the probability but not the certainty of osteopathic medical students' choosing a PCS.

Medical backgrounder: psoriasis.

Psoriasis is a chronic skin disorder that affects approximately 2% of the US and European populations. Psoriatic lesions are extremely characteristic of the disease, which allows for simple diagnosis. A clear understanding of the pathogenesis of psoriasis does not yet exist. Hyperproliferation of keratinocytes is a further characteristic feature. Studies have depicted that the epidermal cell cycle of psoriatic lesions is shortened by approximately eight-fold more than normal. The lesions are classified as erythrosquamous, due to the erythema which develops asa result of involvement of the vasculature, and the involvement of the epidermis with scale formation. The diagnosis of psoriasis can usually be established on clinical grounds. If the clinician is in doubt, a small cutaneous punch biopsy and subsequent histopathological examination can be performed. There are multiple therapeutic options for psoriasis. First-line therapy for patients with moderate to severe psoriasis is the application of topical agents, followed by phototherapy (UVB) for more extensive disease. If extensive disease does not respond to UVB, second-line agents include psoralen plus UVA (PUVA), methotrexate, cyclosporine or other systemic agents, including novel biologic therapies. New psoriasis treatment regimens have been developed and include combination, rotational and sequential therapy.

Calcipotriene and corticosteroid combination therapy for vitiligo.

Corticosteroids and photochemotherapy, using a combination of psoralen and ultraviolet A (PUVA) exposure, are the most widely prescribed therapies for vitiligo. These treatments are not uniformly effective and many patients have inadequate responses. Calcipotriene has been shown to be effective in adults and children with psoriasis when used as monotherapy and in combination with corticosteroids and phototherapy. We hypothesized that since the mechanisms of action for calcipotriene and corticosteroids are different, patients may develop more repigmentation with a combination of the two agents, while decreasing the side effects from both agents. Twelve patients with vitiligo (average age 13.1 years) were advised to use topical corticosteroids in the morning and topical calcipotriene in the evening. Of the 12 patients, 83% responded to therapy, with an average of 95% repigmentation by body surface area. Four of the patients who responded had previously failed trials of topical corticosteroids alone. All of the patients in this group had repigmentation. Eyelid and facial skin responded best to this therapy. None of the patients had adverse reactions to the treatment. Our results show that topical calcipotriene in combination with corticosteroids can repigment vitiligo, even in those patients who were previous topical corticosteroid failures.