Weight loss after sleeve gastrectomy in developmentally delayed adolescents and young adults.

BACKGROUND: Adolescent obesity is a significant factor in caring for patients with developmental delay (DD). Sleeve gastrectomy provides durable weight loss for teens with obesity but requires behavioral change that may not occur in patients with DD. OBJECTIVES: To determine whether patients with DD had similar weight loss and adverse outcomes to patients without a diagnosis of DD after sleeve gastrectomy. SETTING: Academic children's hospital, United States. METHODS: Patients with DD undergoing sleeve gastrectomy were matched to adolescents without DD. Chart review was performed to determine etiology and severity of DD, weight, and body mass index (BMI) change in each group at 3, 6, 9, and 12 months postoperatively. One-year emergency department visits, readmissions, and reoperations were reviewed. RESULTS: Ten patients with DD and 44 patients without DD underwent sleeve gastrectomy between 2008 and 2017. Six patients with DD (60%) had mild cognitive impairment, 3 patients (30%) had moderate cognitive impairment, and 1 patient (10%) had severe cognitive impairment. Patients were 81.5% female, had a mean age of 17.3 years, and had a preoperative BMI of 48.6 kg/m2. Preoperative BMI was similar in the 2 groups, and percent BMI reduction at 1 year was -29% (95% confidence interval: -35 to -23) and -26% (95% confidence interval: -29 to -23) in groups with and without DD respectively (group by time interaction, P = .27). CONCLUSION: Adolescents with DD experience similar 1-year weight loss and adverse events following sleeve gastrectomy to adolescents without DD. Understanding the long-term outcomes for this population is crucial to ensure appropriate implementation of surgical weight loss programs.

Predictors and outcomes of adolescent bariatric support group attendance.

BACKGROUND: Attending support groups connects adults undergoing bariatric surgery to peers and may improve weight loss efficacy. Predictors and outcomes of support group attendance of adolescents undergoing bariatric surgery are unknown. The objective of this cohort study was to determine the rate, predictors, and outcomes of support group attendance in a free-standing adolescent bariatric program. METHODS: Charts of 68 consecutive adolescents who underwent laparoscopic Roux-en-Y gastric bypass or vertical sleeve gastrectomy were retrospectively reviewed, and demographic and anthropometric variables and support group and clinic visit attendance were recorded. Prospectively collected vitamin adherence data were also analyzed. Univariate analyses evaluated characteristics and multivariate analyses evaluated predictors of support group attendance, clinic visit attendance, and vitamin adherence. RESULTS: Of the 68 patients, one third attended 1-3 support sessions, one third attended ≥ 4, and one third were nonattenders. Greater distance from clinical center (P = .01) and caregiver bariatric history (P = .05) were associated with decreased attendance. Only high preoperative body mass index (P<.01) and caregiver bariatric history (P<.01) were independently associated with decreased attendance. Increased attendance was associated with higher 6-month (P = .03) and 12-month (P<.01) clinic visit attendance but not with multivitamin adherence (P = .33). CONCLUSIONS: Caregiver bariatric history and higher preoperative body mass index were associated with decreasing attendance at an adolescent bariatric support group program. This highlights a need to encourage attendance in these patients, because adolescent attendance at support group sessions was positively associated with greater adherence to scheduled clinic visits postoperatively, which may positively influence long-term outcomes.

MRSA: rare in the vagina.

STUDY OBJECTIVE: To determine the prevalence of vaginal Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in sexually active adolescent women. DESIGN: A prospective surveillance study. PARTICIPANTS: Patients included 315 sexually active young women (ages 13-24) undergoing routine pelvic examination and wet mount testing in an urban teen health center. MAIN OUTCOME MEASURES: Prevalence of vaginal S. aureus and MRSA. RESULTS: S. aureus was present in 16 samples for a point estimate of 5.1% (95% CI: 2.6%-7.5%). MRSA was detected in two samples, giving a vaginal prevalence estimate of 0.6% (95% CI: 0.0% -1.5%). No differences were detected in the prevalence of S. aureus by age or race, although no cases of S. aureus were observed in those under age 15. CONCLUSION: The prevalence of MRSA in a sample of sexually active adolescents was as rare as reported in other populations. It is unlikely that vaginal MRSA is a reservoir for community acquired infections.

Changes in human immunodeficiency virus testing rates among urban adolescents after introduction of routine and rapid testing.

OBJECTIVES: To examine human immunodeficiency virus (HIV) testing rates among adolescents during a 3-year period to determine (1) if the rate of testing increased after publication of national recommendations for routine HIV testing in 2006, and again after the introduction of rapid testing in the clinic in 2007, and (2) factors associated with HIV testing. DESIGN: Retrospective medical record review. SETTING: Urban hospital-based adolescent primary care clinic. PARTICIPANTS: Thirteen- to 22-year-old sexually experienced patients who had computerized billing data reflecting testing for sexually transmitted infections, including HIV. OUTCOME MEASURES: Rates of HIV testing for each of 3 one-year phases-phase 1 (pre-routine testing recommendations), phase 2 (post-routine testing recommendations but pre-rapid testing), and phase 3 (post-rapid testing)-and factors associated with HIV testing. RESULTS: In total, 9491 patients were included. The rate of HIV testing in phase 2 was significantly higher than the rate of testing in phase 1 (27.7% vs 12.6%, P < .001). The rate of testing in phase 3 was significantly higher than the rate of testing in phase 2 (44.6% vs 27.7%, P < .001) and phase 1 (P < .001). Factors independently associated with HIV testing included phase, older age, male sex, race, public insurance status, and having a genitourinary-related diagnosis during the same phase. CONCLUSIONS: The HIV testing rates increased significantly following publication of recommendations for routine testing and further increased following introduction of rapid testing. Combining routine and rapid testing strategies may increase uptake of HIV testing among adolescents in primary care settings.

Family experiences with outpatient care: do adolescents and parents have the same perceptions?

PURPOSE: Providing healthcare for adolescents involves balancing parents' and adolescents' needs, and little research addressing, measuring, and achieving this balance has been conducted. A first step for healthcare providers toward achieving this balance is to understand the differences between parents and adolescents regarding perceptions of outpatient care experiences. This study was to explore and compare the experiences of care between parents and adolescents in a primary care setting. METHODS: As part of an institution-wide system to measure patient satisfaction, 170 pairs of adolescent patients aged 11-17.9 years and their parents/guardians who had an outpatient visit at a Teen Health Center located within a large pediatric hospital were interviewed by telephone using both closed- and open-ended questions. RESULTS: Overall, perceptions of care between adolescents and parents were very similar. However, adolescents reported less involvement in decisions about medical care and were less likely to receive understandable answers to questions. A qualitative analysis of responses to open-ended questions indicated that aspects of care important to both adolescents and parents are communication followed by interpersonal skills and technical competence. Parents and adolescents did not always view confidentiality in the same way. CONCLUSIONS: These findings suggest that more time should be spent focusing on the adolescents' needs concerning communication. Healthcare providers should focus on the adolescents' needs by involving them in decisions and providing understandable answers to questions. Both parents and adolescents should be surveyed to measure their experience of care, especially with respect to involvement in care decisions, communication, and confidentiality.

Adolescent preferences for human immunodeficiency virus testing methods and impact of rapid tests on receipt of results.

PURPOSE: Rapid human immunodeficiency virus (HIV) tests may be more acceptable to adolescents and may improve receipt of test results. We conducted a study to determine (a) adolescent preferences for different HIV testing methods (rapid oral fluid vs. rapid fingerstick vs. traditional venipuncture), (b) factors associated with choice of a rapid vs. traditional test, and (c) whether those who chose a rapid method were more likely to receive test results. METHODS: Participants (N=99, 13-22 years old, both genders) were recruited from an urban hospital-based adolescent primary care clinic, agreed to HIV testing with their choice of method, and completed a questionnaire assessing demographic characteristics and attitudes about HIV testing. Logistic regression modeling was used to determine factors associated with choice of a rapid versus traditional test. RESULTS: Half (50.5%) of participants chose rapid oral fluid testing, 30.3% traditional venipuncture testing, and 19.2% rapid fingerstick testing (p < .01). Factors independently associated with choice of a rapid versus traditional method included preference for an oral fluid versus blood test and perceived approval of HIV testing by one's healthcare provider. Participants who chose a rapid test were more likely to receive their test results within the follow-up period than participants who chose a traditional test (91.3% vs. 46.7%, p < .001). CONCLUSIONS: In this study, 70% of adolescents preferred rapid to traditional HIV testing, and rapid testers were more likely to receive their results within the follow-up period. Offering rapid testing may lead to improved receipt of results among adolescents in urban primary care settings.

Education about human papillomavirus and human papillomavirus vaccines in adolescents.

PURPOSE OF REVIEW: The purpose of this article is to review recent literature that may help guide the development of effective, evidence-based strategies to educate adolescents about human papillomavirus (HPV) and HPV vaccines. Educational strategies are essential, given several new and highly effective technologies to prevent HPV and related diseases such as cervical cancer. RECENT FINDINGS: Although little has been published regarding adolescent knowledge about HPV and HPV vaccines, studies conducted primarily in adult women demonstrate that knowledge generally is poor. Studies of adolescent attitudes about HPV vaccines have identified several modifiable factors associated with intention and confidence in one's ability to receive the vaccine, including higher perceived severity of cervical cancer and fewer barriers to vaccination. Studies of clinician attitudes about HPV vaccines have demonstrated that although clinicians generally support vaccination, some report concerns; for example, adolescents may practice riskier sexual behaviors after vaccination. Studies also show that clinicians believe that educational materials developed specifically for adolescents are essential. SUMMARY: The recent literature on adolescent knowledge about HPV and attitudes about HPV vaccines supports the importance of designing developmentally appropriate educational materials for adolescents about HPV and HPV vaccines, and provides guidance for the development of key educational messages.

Development of an HPV educational protocol for adolescents.

STUDY OBJECTIVES: To develop an educational protocol about HPV and Pap tests for adolescents, to evaluate the protocol for understandability and clarity, and to evaluate the protocol for its effectiveness in increasing knowledge about HPV. DESIGN: In phase 1, investigators and adolescents developed the protocol. In phase 2, adolescents evaluated the protocol qualitatively, investigators evaluated its effectiveness in increasing HPV knowledge in a sample of adolescents, and the protocol was revised. In phase 3, investigators evaluated the effectiveness of the revised protocol in an additional adolescent sample. SETTING: Urban, hospital-based teen health center. PARTICIPANTS: A total of 252 adolescent girls and boys in the three study phases. MAIN OUTCOME MEASURES: Pre- and post-protocol knowledge about HPV, measured using a 10- or 11-item scale. RESULTS: Scores on the HPV knowledge scale increased significantly (P < 0.0001) among adolescents who participated in phases 2 and 3 after they received the protocol. Initial differences in scores based on race, insurance type, and condom use were not noted post-protocol. CONCLUSION: The protocol significantly increased knowledge scores about HPV in this population, regardless of sociodemographic characteristics and risk behaviors. Effective, developmentally appropriate educational protocols about HPV and Pap tests are particularly important in clinical settings as cervical cancer screening guidelines evolve, HPV DNA testing is integrated into screening protocols, and HPV vaccines become available. In-depth, one-on-one education about HPV may also prevent adverse psychosocial responses and promote healthy sexual and Pap screening behaviors in adolescents with abnormal HPV or Pap test results.

Personal meaning of human papillomavirus and Pap test results in adolescent and young adult women.

OBJECTIVE: As new cervical cancer screening recommendations are adopted, more adolescents may learn they are infected with human papillomavirus (HPV). The objective of this study was to explore personal meaning of HPV and Pap test results in adolescent and young adult women. DESIGN: The authors recruited sexually active 14- to 21-year-old adolescent girls from an urban teen health center. Participants underwent HPV and Pap testing at baseline and returned 2 weeks later to receive test results and to be interviewed about their responses to test results. The authors analyzed interview transcripts using qualitative methods and developed a conceptual framework to explain participants' responses. MAIN OUTCOME MEASURES: Of the 100 participants, 51% were HPV positive and 23% had an abnormal Pap test. Personal meaning was comprised of four core dimensions: labeling of results, perceived risk of HPV-related disease, personal accountability, and anticipated shame or stigma. The association between test result and personal meaning was mediated through cognitive understanding of test results, which in turn was influenced by education about HPV and prior health experiences. CONCLUSION: Clinicians who communicate HPV and Pap test results to adolescent girls should provide accurate information in a nonjudgmental manner, take into account adolescents' personal experiences with sexually transmitted infections and cancer, and explore personal meaning of results such as anticipated risk and stigma. In this way, clinicians may be able to minimize adverse psychosocial outcomes while promoting positive reproductive health behaviors.

Vegetarian eating for children and adolescents.

During the past decade, vegetarianism has risen in popularity among American families. Well-planned vegetarian diets can satisfy the nutritional needs and promote normal growth of infants and children. Research has highlighted nutritional advantages to vegetarian diets and has indicated that this style of eating can lead to lifelong healthy eating habits when adopted at a young age. Several vitamins, minerals, and macronutrients may be deficient within a vegetarian diet. Careful nutrition assessment and counseling will allow nurse practitioners to play a key role in encouraging families to adopt healthy eating habits to assist in disease prevention.

Psychological, behavioral, and interpersonal impact of human papillomavirus and Pap test results.

BACKGROUND: The purpose of this study was to explore the short-term psychological, behavioral, and interpersonal impact of human papillomavirus (HPV) and Pap results in adolescent and young adult women. METHODS: Sexually active young women 14-21 years of age were recruited using a purposeful sampling strategy from a hospital-based teen health center. Participants underwent HPV DNA and Pap testing at baseline. At a follow-up visit 2 weeks later, they received test results and participated in individual interviews designed to examine the impact of test results. Interview data were analyzed using framework analysis, a qualitative analytical method. RESULTS: The mean age of the 100 participants was 17.2 years, and 82% were black. Fifty-one percent were HPV positive, and 23% had abnormal Pap tests. Psychological responses consisted of affective reactions to abnormal results, empowerment through knowledge of results, and self-confidence to prevent future disease. Personal behavioral intentions encompassed safe sexual behaviors, partner monitoring, and return for screening. Anticipated interpersonal consequences focused on the impact of communication about test results on relationships. Psychosocial and behavioral responses were influenced by the personal meaning participants derived from HPV and Pap results (e.g., perceptions of personal risk and anticipated stigma), cognitive understanding of test results, and such factors as coping mechanisms, locus of control, and relationship quality. CONCLUSIONS: An understanding of young women's responses to HPV and Pap test results may help guide clinical interventions designed to prevent possibly harmful psychosocial and interpersonal responses to HPV and Pap testing but promote healthy sexual behaviors and regular screening.

Comparison of adolescent and young adult self-collected and clinician-collected samples for human papillomavirus.

OBJECTIVE: To examine the concordance between self-collected and clinician-collected samples for human papillomavirus (HPV) DNA. METHODS: Sexually active adolescent and young adult women aged 14-21 years (N = 101) were enrolled in a prospective cohort study of HPV testing. Participants self-collected vaginal samples for HPV DNA, and clinicians collected cervicovaginal samples for HPV DNA and a cervical cytology specimen. We determined concordance between the results of self- and clinician-collected specimens using a kappa statistic and McNemar's test. RESULTS: Of the 51% of participants who were HPV positive, 53% had 1 type, 25% had 2 types, and 22% had 3 types or more; 25 different HPV types were identified. Self-collected samples detected more participants with HPV than clinician-collected samples (45% versus 42%, P =.65). When results were categorized into presence or absence of high-risk HPV types, agreement between self- and clinician-collected specimens was high (kappa 0.72) and the difference between test results was not significant (McNemar's P =.41). However, when all HPV types detected were considered, agreement was perfect in only 51% of those with 1 or more types of high-risk HPV type. There was no association between agreement and age or HPV type. CONCLUSION: Self testing for HPV DNA may be sufficiently sensitive for the detection of high-risk HPV DNA among adolescent and young adult women in clinical settings.

Adolescent beliefs about infertility.

PURPOSE: Explore adolescents' definition of fertility and range of beliefs regarding causes of infertility. METHODS: Qualitative study involving five focus groups that met between April 2001 and December 2001 at a hospital-based adolescent health center. All groups were led by one experienced moderator and observed by two investigators. Audiotapes of the group discussions were transcribed and reviewed independently by three investigators who met and reached consensus on underlying themes. RESULTS: Most adolescents generally understood fertility as the ability to become pregnant. Ten themes emerged as causes of infertility. Anatomic/gynecologic causes generated the most responses and most detailed discussion (e.g., "The coating on the egg is too hard and the sperm can't get in to fertilize the egg."). Other commonly mentioned causes were male factors (e.g., "He cannot produce sperm."), sexually transmitted infections (e.g., "like chlamydia caused scarring in the fallopian tubes"), genetics (e.g.,"a birth defect") and substance use (e.g., "if a man smoke weed all day, the egg may not develop because of problems with his sperm"). Less commonly mentioned themes were stress, contraception, environmental toxins, violence and injury. CONCLUSIONS: Most adolescents defined fertility as the ability to become pregnant and reported an extensive range of beliefs about the causes of infertility. Providers should consider eliciting adolescents' definitions of fertility and also exploring beliefs about causes of infertility with their patients when counseling about sexuality and contraception to determine if an adolescent has inaccurate beliefs about their fertility.