Little League Shoulder and Subsequent Proximal Humeral Fracture in the Setting of Human Growth Hormone Use: A Case Report.

CASE: A 16-year-old right-hand dominant male baseball player presented with little league shoulder in the setting of recombinant growth hormone utilization for growth hormone deficiency. After a prolonged treatment course, including physical therapy and throwing programs, the patient returned to baseball but suffered an ipsilateral proximal humerus fracture around the growth plate. CONCLUSION: The occurrence of such an injury in the context of human growth hormone treatment merits consideration in youth athletes undergoing similar treatment regimens. Clinically, we recommend screening pediatric patients with sports-related epiphysiolysis for current or previous growth hormone use because of the possible prognostic implications of such treatment.

Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic.

PURPOSE: To describe the first 30 days of rapid adolescent telehealth scale-up in response to the coronavirus (COVID-19) pandemic at a single academic medical center and assess for disparities in visit completion rates by patient characteristics. METHODS: Visit outcome and patient demographic data were obtained via electronic health record (EHR) reports. Telehealth visit completion rates were compared by patient characteristics using the chi-square test and t-test. We used zip code data to generate latitude- and longitude-based maps of the range and density of service delivery. Patient cases highlighting challenges and opportunities for adolescent telehealth were summarized. RESULTS: Between March 16 and April 15, 2020, 392 telehealth visits were scheduled in 331 unique patients, with an 82% appointment completion rate. Video visits were conducted for eating disorders (39%), contraception/menstrual disorders (22%), gender-affirming care (17%), general adolescent medicine (15%), HIV treatment (6%), and substance abuse (1%). The majority of telehealth patients were female Caucasian minors with private insurance. There were no significant differences in telehealth visit completion rates by age, sex, gender, or insurance. Patients coded as non-white (African-American, Asian, or other) in the EHR had lower visit completion rates than white patients (p = .003). Telehealth patients were distributed across five states, with the highest concentration in the zip codes nearest to the clinic. CONCLUSIONS: Rapid scale-up of telehealth for Adolescent Medicine was achieved at this large academic medical center. Future implementation research is needed to assure telehealth reaches adolescents without widening health disparities.

Assessing Delaware Parents' Knowledge, Attitudes and Preferences About Long Acting Reversible Contraceptives for Teens Using Participatory Action Research.

To decrease barriers to long-acting reversible contraception (LARC) for teens, this study aimed to reveal knowledge, attitudes, and beliefs that parents have about LARC. METHODS: A participatory action research approach was used. We recruited a diverse group of community researchers who participated in all phases of our study. Four focus groups were recruited using snowball sampling. Two researchers used a values coding process to code data independently. The team met to identify emerging themes. RESULTS: The 46 parents were predominately female and ethnically diverse. Preventing teen pregnancy was salient although a double standard between parents of boys and girls became apparent. A key theme that emerged was the importance of prevention of sexually transmitted infections (STIs). There were some reservations about LARC provision in school-based health centers. Another theme was the need for access to confidential birth control for other teens but not for their own teens. Lastly, the advantages of LARC mentioned were effectiveness and ease of use. The disadvantages were increased STIs, risky behavior, hormonal changes, and side effects. CONCLUSION: Most of the parents in our study had limited knowledge of LARC. They were aware of its benefits but were uneasy about actual and perceived side effects.

Ovarian Cystadenoma in a Trafficked Patient.

The topic of child sex trafficking is receiving increased attention both in the lay press and in research articles. Recently, a number of physician organizations have issued policy statements calling for the education and involvement of physicians in combating this form of "modern-day slavery." Primary care and emergency medicine physicians have led these efforts, but a number of these victims may present to surgeons. Surgeons are in a unique position to identify trafficked patients; during the process of undraping, intubation, and surgical preparation, signs of trafficking such as tattoos, scars, dental injuries, and bruising may be evident. In addition, these patients may have specific needs in terms of anesthesia and postoperative care due to substance abuse. Here, we report the case of an 18-year-old girl with a history of sexual exploitation who presents for cystadenoma excision. To our knowledge, this is the first report of a sex-trafficked pediatric patient presenting for surgery.